POSTERS: Blood Pressure Measurement

POSTERS: Blood Pressure Measurement

El LEFT VENTAIGULAR HYPERTROPHY (LVH) IN ESSENTIAL HYPERTENSION OF NON-DIPPER ON THE TWO CONSECUTIVE DA VS. Y Mochizuki, M Okutani, H lwasaki, I Kohno, S Sano, S Mochizuki, K Umetani, T lshihara, H lshii, H ljiri*, S Komori, and K Tamura*. Dept. of Med. Yamanashi Medica! University, Yamanashi, Japan.

We assessed the reproducibility of dipper I nondipper and to estimate the prevalenee of L VH in "true" non-dipper. Noninvasive ambulatory BP and HR monitoring tor 48hrs. in every 30 min. and echocardiography were performed in 254 pts. with essential hypertension. These pts. were divided into two groups by presence (dipper) and absence (nondipper) of a reduction of more than 1 0% of daytime pressure in the consecutive days.1) Dipper on the 1 st. day remained dipper on 2nd. day in 72% and changed to non-dipper in 28%. 2) Non-dipper on the 1 st. day remained non-dipper in 69% and changed to dipper in 31%. 3) LV mass index (LVMI) was compared among 3 groups (Fig.). LVMI of nondipper and non-dipper showed significantly higher compared with the rest of the groups.

LVMI(g/m')

--126±5

--139±6

day *p<0.05

Key Words: ambulatory blood pressure, non-dipper, lef! ventricular hypertrophy, nocturnal reduction rate

E3

WHA T WOULD BE THE DESIRABLE CIRCADIAN BLOOD PRESSURE PROFILE IN ESSENTIAL HYPERTENSION? H Ijiri*, M Okutani, Y Mochizuki, H Iwasaki, I Kohno, S Mochizuki, K Umetani, H Ishii, S Komori, K Tamura*. The Department of Medicine, Yamanashi Medical University, Yamanashi, Japan.

We evaluated the circadian variation of blood pre ss ure (BP) and left ventricular hypertrophy (L VH) in

essential hypertnsion. Ambulatory BP monitoring (Colin, Japan) for 48 hours every 30 minutes and echo

cardiogram were performed in untreated 150 patients with essential hypertension. Mean daytime and nighttime BPs were analyzed by reviewing the palients' diaries. These patients were divided into five groups by the noctumal reduction rate (NRR) of systolic BP. NRR(%) = (daytime mean- nighttime mean) I (daytime mean) X 100. LVH was considered present iî the LVMI > 125 g/m2 in male, or > IJ 0 g/m 2 in female.

mean + SD, * <0.05 as com ared with A.

NRRt%)

Case (M:Fl

Age(y.o.)

48h-SBP

48h-DBP

< 5 5- 10 10- 15 15- 20

23(12:11) 41(20:21) 42(21:21) 26(14:12)

55±8 55-t 10 55±10 54± 11

144±9 145± 15 144± 15

85±6 85±9 86± JO

143 ± 15

85 ±9

êO "::

I '(9:9)

53 ±7

140±8

84 ± 8 LVM!(g/m'l 1451:36 139:±.37 141±43 *125±37 134±29 LVH % 82.6 75.6 64.2 *53.8 66.7

In conclusion, the prevalenee and the severity of L VH was lowest in the group D. These results demonstrate that the most desirabie NRR of BP is 15 ~ 20% in essential hypertension. Key Words: Ie ti ventricular hypertrophy, essential hypertension, ambulatory blood pressure monitoring.

AJH 1996; 9:102A-115A

E2 EFFECT OF KC! ON CENTRAL A OR TIC PRESSURE IN ELDERLY PATIENTS ON l3 BLOCKING DRUGS. TO Morgan*, Department of Physiology, University of Melbourne, Parkville, Australia.

Central aartic pressure and brachial artery pressure may not correlate due to variations in peripheral resistance and compliance of the large conduit arteries. Central aortic pressure can be estimated using radial artery tonometry and an algorithm (SphygmoCor). In a previous study 13 blocking drugs have increased in elderly people the central aortic augmentation index. Th is study looked at the effect of KC! (48 mmol/d) supplementation on central aartic pressure augmentation in people on P blocking drugs.

The patients (n= 10) were age > 65y and had essential hyperlension (BP > 160/90). They all received atenolol 50 mg/d and after 4 weeks were given KC! for 4 weeks. The results in the placebo, atenolol and atenolol + KC! period were compared. Clinic BP were 172/94, 156/88 (p <0.01) and 154/87 (p <0.01) respectively. The augmenled central pressure was 26 ± 5 n.mHg on placebo; 33 ± 4 mmHg (p <0.05) on atenolol; and 21 ± 4 mmHg (p <0.05 compared to atenolol) on atenolol + KCI.

Th is study indicates that measurement of brachial artery pressure may overestimate the extent to which the central aartic systolic pressure is reduced. Potassium supplementation improved central aartic pressure with no significant effect on the brachial artery pressure. The mechanism of this effect whether it alters compliance or peripheral resistance cannot be determined from this study.

Key Words:

E4

Reflected waves, tonometry, 13 blocking drugs, central aartic pressure, KCI

LEFT VENTRICULER HYPERTROPHY AND MORNING RISE OF BLOOD PRESSURE IN ESSENTIAL HYPERTENSION

H Iwasaki, H Ijiri*, M Okutani, Y Mochizuki, Kohno, S Mochizuki, K Umetani, H Ishii, S Komori, K Tamura*. The Department of Medicine, Yamanashi Medica! University, Yamanashi, Japan.

We evaluated correlation between the morning rise of blood pressure (BP) and left ventricular hypertrophy (L VH) in hypertnsion. Ambulatory BP monitoring (Colin) for 48 hrs. every 30 min. and echocardiogram

were performed in untreated 90 pts. with essential hypertension. Awakening time were analyzed by reviewing the pts' diaries. Pts. were divided into three groups by the momig rise ratio ( ~ MR) of systolic BP. ~ MR(%) = (4hrs.mean before awakening - 4hrs.mean after awakening) I ( 4hrs.mean before awakening) X I 00. L VH was considered present if the L VMI > 125 g/m2

in male, or > 110 m2 in female. Grou B C ~MR(ç)

Case IM:F)

Agely.o.)

48h-SB p

48h-DBP

LVMllg/ m'

10-20

36 I 19: 17J

52:±.12

135±7

80±5

*118±27

20-30

29 I 15:141

51 ±IJ

135±8

80±5

30"::

25(13:12)

52± JO

136±9

81 ±7

123±39 142±40 L VH 'ii * 50.0 5 1.7 66.7

mean ± SD, * p<0.05 as compared with group C. In conclusion,prevalence and the severity of LVH

was lowcst in the group A. These results demonstrate that the most desirabie moming rise ratio of BP would be 10~ 20% in essential hypertension. Key Words: left ventricu Ier hypertrophy,essential hyper-

tension,moming rise,ambutory blood pressûre monitoring.

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AJH-APRIL 1996-VOL. 9, NO. 4, PART 2

ES THE CIRCADIAN RHYTHM OF TOTAL VASCULAR TONE AND LEFT VENTRICULAR HYPERTROPHY IN ESSENTIAL HYPERTENSION. H.Mori', Y.Hoshi, Y. Yokono, N.Fujiwara and H.Toyamori.Aomori Prefectural Central Hospital,Aomori,Japan.

we studled the relationship between the circadian rhythm of total vascular tone (TVT) index (TVTI, calculated as total vascular resistance) and left ventricular hypertrophy (LVH).The subjects were 51 patients with essential hypertension (EH) and 17 controls. Patients with EH were divided into stage I to ill according to WHO's stage classification. Noninvasive ambulatory blood pressure(BP) monitors, noninvasive continuous cardiac output (CO) monitors and a Holter electrocardiography were attached over 24-hour period and BP,heart rate, CO and TVT ((MBP/CI)X 1,332 dyne/sec/cm-5) were measured. TVTI was calculated based on the value at 2:00a.m. as follows:[(each hourly value-value at 2:00a.m. /value at 2:00a.m. ]X 100. LVH was determined by echocardiographic criteria using left ventricular mass (LVM) index. Twenty-four hour period were divided into waking (W) hours and sleeping (S) hours. The value of TVTI differences was calculated as follows: TVTI in S hours-TVTI in W hours. The values in bath W and S hours of TVTI, the value of TVTI differences and the value of LVM index were significantly higher in this order: stage ill > stage II > stage I > control group. LVM index showed significant positive correlation with TVT index. It suggests that the greater the severity of hypertension, the greater might be the circadian rhythm of TVT and LVM, and there is close relationship between TVT and LVM.

Key Words: circadian rhythm, total vascular tone, left ventricular hypertrophy

E7 DISCREPANCIES BETWEEN MEAN OFFICE AND AMBULATORY BLOOD PRESSURES IN PRIMARY CARE KA Pearce*, G Evans, J Summerson. Bowman Gray School of

Medicine, Wake Forest University, Winston-Salem, NC

The imparianee of the White Coat (WC) Effect in unselected patient populations has been debated. We examined

the accuracy of routine office blood pressure (OBP) readings by nurses, plus standardized OBP readings, in terms of their relatioriships with mean ABP among adults aged 46 to 75 years. In this observational, cross-sectional study, 75 randomly-selected primary care patients made 6 office visits for OBP measurements, and had 24-hr ABP monitoring done twice. Mean ABP levels were compared with mean OBP levels derived trom 1 to 6 visits. The sample included 29 men and 46 wamen; with 18 blacks and 57 whites; 21 subjects were taking antihypertensive medication. Half of the sample had systolic BP between 130 and 160 mm Hg at Visit 1. Routine OBP readings by nurses and standardized readings by a research assistani had nearly equal accuracy with respect to mean ABP. The correlation between mean OBP and mean ABP rose with the number of

visits averaged [maxima! for 24-hr ABP: r = .85/.75, (sys/dias)

p<.01), with most of the gain obtained within 3 visits. A

discrepancy of~ 10 mm Hg between observed mean ABP and mean ABP estimated trom mean OBP persisled in 18% to 20%

of subjects alter 6 visits, regardless of whether mean awake or

mean 24-hr ABP was used. The prevalenee of a WC Effect of~ 10 mm Hg feil as the number of visits averaged to derive mean

OBP rose, but the rate of~ 10 mm Hg underestimation of mean ABP did nol fall. Clinical and demographic variables did nol

significantly affect the relationships between OBP and ABP. We

conclude that readings trom at least 3 office visits should be

averaged to estimate mean ABP. However, mean ABP vs OBP

discrepancies persist alter 6 visits, and multiple visits do nol

reduce the rate of underestimation of mean ABP. ABP

monitoring probably provides unique inforrnation about mean BP that cannot be captured by repeated OBP readings. Key Words:

White Coat Effect, primary care, maasurement error

POSTERS: Blood Pressure Messurement 103A

E6 Clinic and ambulatory BPs show different patterns and relationships in rnales and temales Massimo Criooa, Enrico Boni, Gianpaolo Damiani, Carlo Alicandri, Luciano Corda, Augusto Zaninelli, llaria Notaristefano. Raflaele Fariello. Dpt lnternal Med, Spedali Civili, Brescia, ltaly

In hypertensive patients clinic pressures are tipically higher than ambulatory pressures. Aim of the present study was to campare clinic BPs and ABPMs in patients of both genders with

mild hyperlension (an elevated blood pressure was the only deleetabie abnormality). In this study we carried out 24-h ABPM

using an A&D TM 2420, model 6, in 180 never treated rnales (aged 25 to 65 years, mean 48) and 128 never treated temales

(aged 25 to 65 years, mean 49). These patients were addressed

to our Iabaratory by the family physician to establish a correct diagnosis of hyperlension and to start drug treatment if necessary. Clinic BP measured in the morning belare ABPM insertion was 153±:1 21 93±9 mmHg in rnales and 152± 121 94±9 mmHg in females. Resuks (mean+SD) were as follow

MALES FEMALES SBP DBP SBP DBP

24-hour 140±16 86±10 133±17 86±11 daytime 145±16 88±10 136±18 88±12 night-time 126±19 78±12 122±19 78±12 In conclusion, 1) clinic systolic and diastol ie BPs were similar in both genders; 2) clinic systolic and diastolic BPs were

significantly lower than daytime ABPs in both genders (p<0.0005); 3) daytime systolic ABP was significantly higher in

rnales than in temales (p<0.0005); 4) night-time systolic ABP was higher in rnales than in temales (p<0.05); 5) daytime and night-time diastolic ABPs were similar in bath genders.

Hypertensive rnales show higher systolic ABP than females:

therefore they need a more intensive intervention to prevent cardiovascular risk related to high systolic BP. Furthermore,

significant dilterenee between clinic BPs and ABPs in bath

genders confirm that the true pressure may be obtained over a prolonged period of observation in mild uncomplicated hypertensive patients.

Key Words: clinic BP, ambulatory BP, gender diflerences.

ES PHARMACODYNAMICS OF MA-HUANG IN NORMOTENSIVE

PATIENTS USING 24 HOUR AMBULATORY BLOOD PRESSURE

MONITORING LM White. SFGarrlner*, MA Marx*, BJ Gurley. University of Arkansas

for Medica! Sciences College ofPharmacy, Little Rock, AR.

Ma-Huang is a shrub grown in China for use in herbal medicines. The

plant's active ingredient is ephedrine, a sympathomimetic agent that

causes vasoconstriction and cardiac stimulation. Rises in blood

pressure and heart rate, insomnia, dizziness, headache, and

nervousness have been noted in patienls receiving ephedrine. Herbal

produels containing Ma-Huang are loosely regulated by the Food and

Drug Administration and are widely available in health food stores as

energy or diet pills. The purpose of this study was to delermine if

ingestion of Ma-Huang herbal produels resulls in significant changes

in blood pressure or heart rate in normotensive, healthy adult

volunteers. Eleven subjecls were enrolled in the study (six female, live male) and

onderwent ambulatory blood pressure monitoring every l 5 minutes

from 7:00AM-8:00PM on two occasions. On the second day, four

capsules ofMa-Huang were ingested at 8:00AM and 5:00PM with a

light snack. Subjecls maintained the same level of physical activity

and caffeine intake during both days. Baseline and treatrnent phase

(8AM-8PM) systolic blood pressure, diastolic blood pressure, and

heart rate were compared using a two tailed student's t-test, a=0.05.

Six of eleven subjecls demonstraled a significant increase in HR (78±6

bpm vs. 86±9 bpm) with Ma-Huang administration. Three persons

had a slight increase in HR and two were unchanged from baseline.

Two individuals exhibited statistically significant rise in systolic blood

pressure, another had a significant increase in diastolic blood

pressure. One subject and three subjecls exhibited a decrease in

systolic blood pressure and diastolic blood pressure while taking Ma

Huang. These findings indicate that Ma-Huang administration resulls

in increases in heart rate in most normotensive individuals, but

without a clear trend in raising or lowering blood pressure.

Key Words: Ma-Huang, Ambulatory Blood Pressure

Monitoring, Herbal Medicine

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104A ASH XI ABSTRACTS

E9 REPRODUCIBILITY OF AMBULATORY BLOOD PRESSURE MONITORING IN NORMOTENSIVE SUBJECTS. NR Musso C Vergassola, M Giacchè, C Barone, G Lotti. Department of lntemal Medicine, Univarsity of Genoa Medica! School, Genoa, ltaly.

Ambulatory blood pressure monitoring is an expanding diagnostic tooi in hyperlension research and clinical practica. The study of the reproducibility of monitoring data is still dabated. Generally, by means of traditional statistics, the reproducibility of ambulatory blood pressure monitoring seems excellent. Nevertheless, by means of the more aggressive agreement analysis, this repeatability seems less impressive. Data on ambulatory monitoring repeatability ware obtained in normotensive and hypertensive patients, even as long-term reproducibility. All authors considered a similar approach, i.e. the comparison of two data sats. Here we analyzed data from 24 healthy subjects (age 24 to 38, 10 females) where ambulatory monitoring was repeated tour times at 28 day interval.

Maan 24 h sys mmHg Maan 24 h dia mmHg First 121.8 (24 h SD 11.80) 76.56 (24 h SD 10.59) Second 120.4(24hSD12.13) 75.00(24hSD 11.12) Third 120.1 (24 h SD 10.89) 75.81 (24 h SD 10.06) Fourth 119.8 (24 h SD 11.12) 75.00 (24 h SD 9.81) ANOVA showed a nol significant difference among the tour data sets. Agreement analysis showed an aceapiabie agreement (6 mmHg systolic and 6 mmHg diastolic) aftar the analysis of the tour data sats. The agreement was better than in the first two data sats ( 13 mmHg systolic and 10 mmHg diastol ie). Here the agreement limits are 2SD of the differences between successive ABPM (two data sets) and the 2SD of the distribution of SD in tour data sets. Our data seem to suggest that ABPM reproducibility is satisfactory aftar soma 'training' , because adaptation may occur.

Key Words: Ambulatory Blood Pressure Moni taring, Reproducibility.

Ell REPRODUCIBILITY OF "NON-DIPPER" STATUS OF AMBULATORY BLOOD PRESSURE WHEN "ON CALL". CG Calvo, CR Hcrrcra, JZ Parra*, A Arcllano, and L Hcrrcra. Univcrsity ofGuadalajara (Mexico) and UT-Houston Medica! School, Houston, Tx.

Wc cvaluatc thc rcproducibility ofthe noctumal '"nonclipper" status in 30 norrnotcnsivc Intcmal Medicinc rcsidcnts, aged 27.1±2 ycars ( 14 Mand 16 F), Ambulatory BP was mcasured, with an automatcd, noninvasivc oscillomctric device (Pulse Trend Hillusa), and blood prcssure (BP) was registercd automatically cvcry 15 min during thc day and 20 min during the night time, first the normal day of work (8 h) and comparcd with on call day (24 h in thc hospita!), no more than a weck apart. Subjects wcrc classificd according to whethcr thcir mcan da~timc (07.00-22.00 h) systolic BP, diastolic BP or bath levels dccrcascd by <10% ("non-clippers") during thc nighttime (22:00-07 00 h). 24 h systolic and diastolic BP incrcascd thc day "on call" from I 07/73 to 122/77 nunHg (p-; 0 05) and during nighttimc I 01/67 to I 07/71 mmHg (p< 0 05), thc results are presenled in thc tab Ie:

c ompanson o f"N d' on- rppers "b SBP DBP b h >y or ot

Criteria OffCall On Call Persisled

SBP 15 (50%) 18 (60%) 8 (26%)

DBP 8 (26%) 10 (33%) I (3%)

SBP+ DBP 6(20%) IO (33%) I (3%) SBP~Systohc BP, DBP~ D1astohc BP.

Even though thc numbcr of"non-dippers" incrcascd the day on-call, only onc was a bic to keep this status during both ambulatory BP rccordings. lt is possiblc that at least in norrnal individuals thc "nonclipper" status is a normal variant of BP variability Key Words:

Ambulatory BP monitoring, "Non-clipper", Reproducibility.

AfH-APRIL 1996-VOL. 9, NO. 4, PART 2

ElO COMPARISON OF HOME, OFFICE AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH DIASTOLIC HYPERTENSION. WE Haley•, TM Harris, CT Tucker•, PK Zachariah* Brunswick, GA and Mayo Clinic, Jacksonville, FL. The purpose ofthis study was to relate BP measurements obtained by patients at home with those obtained in the office (OBP) and with ambulatory monitoring (ABP) and to campare how these rnay relate to careliovascular endpoints in a cohort of patients being treated for stage I! and lil diastatic hypertension. 92 patients with diastolic BP between I 00 and 115 mmHg were randomly assigned to eliastolie BP target subgroups ( < 80; < 85; or < 90) according to the HOT Study Protocol. 54 were male; 38 fernale; 19 black; 4 eliabetic. Average age was 62 +/- 9 years. Prior to treatment and after 12 months, the following data were collected: 24h ABP (SpaceLabs 90207); sets of 3 home BP measurements, am and aftemoon, for 7 consecutive days (V isomat OZ2/D2 International); sets of 3 office BP measurements also obtained with the Visamat device; as well as echocareliography and 24h microalbumin excretion. Both single day systolic home BP (142 +/- 19 mmHg) and 7 day (138 +/- 18) averages were noted to significantly correlate with ABP (133 +/- 14) and OBP (135 +/-17)(p < 0.0005); whereas only 7 day eliastolie home BP averages (84 +I- I 0) were significantly correlated with ABP (82 +/- 8) and OBP (82 +/- I 0) (p < 0.05). Of34 patients whose average systolic home BP was >140, 13 alsohad mean daytime ABP>I40 and 19 had OBP> 140. There was a significant correlation between home BP and OBP (p<0.05) and ABP (p<O.OI) in this subgroup. Of 15 whose average eliastolie home BP was> 90, 7 had mean daytime ABP>90 and 6 had OBP>90. There were no significant correlations between these BP subgroups and change in microalbumin excretion or left ventricular rnass at the 12 month interval. Muhiple standarelized measurements of BP by patients at home yield averages which relate well to ABP, although they are somewhat higher (p < 0.05). Longer follow-up of this cohort rnay help clarify the relationship between home BP and surrogate careliovascular endpoints. Key Words: home blood pressure, arnbulatory BP monitoring.

E12 CAN LABORATORY BLOOD PRESSURE MEASURES PREDICT AMBULATORY BLOOD PRESSURE? Majahalme s.~..t, Twjanmaa V', Weder A'*, Lu H' ,Vriz 0' Tuomisto M' and Uusitalo A' ' University of Tampere, Tampere, Finland and ' University of Micbigan, Ann Arbor, USA The aim was to campare differences in the ability to predict real life blood pressure (BP) between casual, and laboratory postural and exercise BP in normolension and mild hypertension. A series of standardized Iabaratory tests [10 minutes sitting (SIT) and supine (SUP),9 minutes standing (STA), dynamic (ERG) and isometrie exercise (HG)] were performed using intra-arterial BP recording in 97 healthy, unmedicated men, initially classified as normotensive (NT, n=34), borderline (BHT. n=29) or mildly hypertensive (HT, n~34) by repeated casual (CAS) measurements. After testing, a 24h intra-arterlal ambulatory BP (IAMB) recording was obt.ained while subjects performed their normal activities. Day (DA Y) and night (NJTE) periods were analyzed as well as 24h averages for SBP and DBP using Pearson correlations and multiple linear regressions. In NT SUP SBP best predieled IAMB measurements (r range .39 to .69, p< .05- .OOI). In multiple regression, SUP SBP explained 49% of 24h SBP varianee (F=12.4,p~.OOI). For BHT, SUP SBP was also the best predietor (r range .09 - .64, p ns- p< .OOI), and it explained 37% of 24h SBP varianee (F~. 15.6, p=.0005). In HT ERG DBP correlations were best (r range .52 - .75, p< .01- .OOI). ERG SBP explained 49% of 24h SBP (F~31.0, p=.OOOO) and 56% of 24h DBP (F~35 .4, p~.OOOO). Correlations were generally better with DA Y than NITE. In genera!, CAS SBP correlated somewhat with IAMB in NT, but more weaker in BHT and HT. CAS DBP instead correlated only in NT and HT with IAMB. To conclude, CAS BP is less closely related to IAMB than Iabaratory BP, but even Iabaratory BP generally explains less than 50% of IAMB variance. Stressors such as exercise are useful only in HT. For BHT the prcdiction of IAMB with laboratory measures was even weaker than in other groups, and thus ambulatory measurements cannot be replaccd by short-duration Iabaratory measurements and stress tests. Key Words:

casual BP, intra-arterlal Iabaratory BP, intra-arterlal ambulatory B P, exercise tests, borderline hyperlension

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E13

THE CHARACTERIZAT!ON OF THE SYSTEMIC ARTERIAL CIRCULATORY SYSTEM IN TERMSOF

lTS CHARACTERISTIC MECHANICAL COMPLEX

IMPEDANCE IS RENDERED INTO A NEW NON

INVASIVE OFFICE BASED SCREENING METHOD

FOR THE EARL Y DETECTION OF SILENT

ATHEROSCLEROSIS. DS EDELSCHICK

(UNAFFILIATED). WEST NYACK, NEW YORK

Our clinical Iabaratory has rendered into practice

a methodology allowing direct measurement of

systemic arterial complex mechanica! impedance.

Using simuitaneously arterial tonometry and Doppier

ultrEtsound meé:surement of radial artery pressure

and intraluminal blóod velocities: mechanica!

impedance spectra for .each patient were computed.

Retrospective statistica! analysis demonstraled a

streng correlation between their estimated

characteristic impedance and their established

diagnosis of coronary ar carotid artery

atheroslcerosis, ( n=78, p< .001, one way analysis of

variance). Noninvasive pulse wave analysis for the early

deleetion of vascular disease as accomplished by

this new direct measurement of arterial system

mechanica! complex impedance is contrasled with

the prior use of modified Windkessel modelir,g

methods that employ arterial pressure contour

analysis and estimated cardiac output to compute a

curve fitted salution for oscillatory compliance.

Abnormalities of vascu!ar compliance should by this

direct methad be more readily discernible.

Key wards: atherosclerosis, characteristic

arterial mechanica! impedance, arterial tonometry,

ultrasen ie volumetrie flow meter.

ElS CORRELATIONS AMONG DEFINITIONS OF SALT

SENSITIVITY IN AFRICAN-AMERICANS. LP

Svetkey* and K Andersen. Duke University Medica!

Center, Durham, NC.

Salt sensitivity (SS) is considered a hallmark of

hyperlension in African-Americans (AA). The use of

various definitions of SS in clinical research has made

camparisans among different studies difficult. We

determined the extent to which 3 commonly-used definitions

ofthe SS phenotype are correlated. In a CRU protocol,

102 AA adults received 21iters ofintravenous normal saline

over 4 hours. The next day, subjects took three doses of

furosemide (total dose I mg!kg lean weight). SS was

detlned as the increase in mean arterial pressure (MAP) with

sodium-loading (MAPt), the change in MAP from salt

loaded to salt-depleted state (MAP~). and the decreasein

MAP with lasix volume depletion (MAP.J.. ). Results are

presenled as Pearson correlation coefficients:

Mean +/- SD Correlations

MAPt(mmHg) U±70 ""'] j MAPA(mmHg) ·U±X.O -0.2R*

MAP,l,(mmHg) }) ± 7.0 05~

*p:;.OI **p:;.tMlOI

These data suggest that 3 commonly-used definitions ofthe

SS phenotype are correlated in African-Americans, and are

presumably measuring the same (patho )physiologic

phenomenon.

Kev W.or.ds: senstltvtty

hypertension. Atrican American, race, salt

POSTERS: Blood Pressure Measurement 105A

E14 AGE BASED DIFFERENCES BElWEEN OSCILLOMETRIC

AND AUSCULTATORY MEASUREMENT TECHNIQUES

T.J. Brinton*. E.D. Walls, S-S Chio. Pulse Metric, Inc. San Diego,

CA.

Although both auscultatory (AUSC) and oscillometric (OSC)

measurement techniques have been examined extensively, the

variability between these two methods with respect to age still

needs further investigation. We evaluated 154 (50M/104F)

subjects, ranging in age from 11 to 85 years (mean±SEM = 45±1.6

years), for systolic (SBP, mmHg) and diastolie (DBP, mmHg)

blood pressures using bath techniques. Two qualified nurses used

korotkoff sounds to determine SBP (phase I) and DBP (phase IV)

during simultaneous monitoring by a Pulse Dynamic OSC

technology. This previously reported OSC technology utilizes

phasic changes in the cuff pulsation signa! to delermine SBP and

DBP. Values for each subject reflect the average of three

recordings. Subjects were placcd into one of three age groups:

Group I (ages 11~32, n=51), Group 2 (ages 33~54, n=51).

AGE Group 1 (23±0.7) Group 2 (42±0.8) Group 3 (70+1.1)

AUSC OSC AUSC OSC AUSC OSC SBP 114±1.8 119±1.8 120±1.6 12Hl.6 145±2.7 148±2.6

DBP 67+1.2 65+1.2 74+1.2 73+1.1 74+1.4 75+1.4

Group 3 (ages 55~85, n=52) (TABLE). SBP was significantly

lower in Group I using the AUSC methad (p=0.03). A similar

trend was observed in group 2 (p=0.06). However, there was no

significant difference in SBP between the two methods in group 3

(p>O.l). Jntcrcstingly, DBP showcd na significant variation for any

group (p>O.I). The difference in SBP may be attributed to the

diffieulty in idcntitying phasc I korotkoff sounds for younger

subjects. These subjccts generally have more elastic arteries that

may dampen phase I sounds, and thus make AUSC determination

of SBP quitc difficult. This phcnomenon may not bc a factor at

D BP duc to differing hcmodydnamic conditions.

Key Words: Oscillometric, Auscul tatory,

Blood pressure measurement

E16 DAY-NIGHT DIFFERENCES OF AMBULATORY BLOOD

PRESSURE MONITORING IN NORMOTENSIVE PATIENTS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD). J Mora-Maciá, T Doilate, J Ocón, M Rodá, and P Barceló.

Fundación Puigvert, Servicio de Nefrologia, Barcelona , Spain.

Clinical studies with ABPM have shown that some cardiovascular complications tend to be more frequent in non-dippers and, consequently, sulfer a Jonger duration of exposure to high BP levels over thc 24 h. Wc studicd the day-night dilTerences of BP in nonnotcnsivc paticnts undergoing CAPD (Gr. I) and we compared with two groups, one with normal renal function (Gr. 2) and anothcr undergoing hcmodmlysis (Gr.3). The tluce group~ \VCrc

matched for age, sex and diastolic diurnal BP. We performed a 24-h ambulatory monitoring (Novacor DIASYS 200) taking rccordings at 30 minutes intervals, divided into two time pcriods: diurnal

(from 0800 to 2200 hours) and nocturnal (from 2300 to 0700

hours). No antihypertensive drugs were taken. The Gr. I. aged 4 7

(39-68) years, 4 male and 4 female, had a daytime BP of

118±27/80±13 mmHg and a night-time BP of 111±27175±13 mmHg. The Gr. 2, aged 49 (36-66) ycars, 5 male and 5 femalc. had a diurnal BP 124±16/83±10 mmHg and a nocturnal BP 113±20174±9 mmHg. Thc Gr. 3, aged 48 (36-62) years. 4 male

and 4 female, had a diurnal BP 139±29/80± 16 mmHg and a

nocturnal BP 135±24179±18mmHg. Thc mcan values of mean BP (MBP) + SD were:

Diw·nal k/Bl' Noc:lurnal Da.v-mght

11111111~ .\/Bl'mm/1~ di . erence.~·

Gr.l 93±17 87±17 -5.8±3.3 Gr. 2 96±10 87±11 -9.5±5.2 . Gr. 3 99±15 98±18 -L3±H t. t

• p<0.05 compared to Gr. I. t p<0.05 comparcd to Gr. I t p<0.005 comparcd to Gr. 2. Continuous ambulatOI) peritoncal dialysis impraves thc day-nigth

BP pauern that is flattencd in patients undcrgoing hcmodialysis.

Key Words: Peritonea! dialysis, hemodialysis, ambulatory monitoring, blood pressure, non-dippers.

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E17 BLOOD PRESSURE MONITORING IN ELDERL Y PA TIENTS UNDERGOING HEMODIAL YSIS PROGNOSTIC JMPLICATIONS. J Mora-Maciá. J Ocón, T Donate, I Agraz and P Barceló. Fundación Puigvert, Svcio. Nefrologia, Barcelona, Spain.

The patients in hemodinlysis has an increase in cardiovascular mortality. We foliowed up prospectively during 3 yrs cldcrly patiellts in hemodialysis that we performcd a BP monitoring (BPM) (Novacor DIASYS 200) in 1992 in the Hospita! We look recordings at 30 minutes intervaL dividcd into to time periacts diurnal (08011 to 2200) and nocturnal (2201 to tl759). Wc starled the BPM aftcr the hemodialysis session, during thc rccording thc subjects were frcc to move within thc hospita! area and to cngage in the usual social actîvities. In the group L 7 patients had cardiovascular cvcnts: 2 fata! strokes, I fatal ML 2 non fatal MI and 2 with coronay cvents. Thc group 2, matchcd for agc. sex and office diastolic BP. did nat have cardiovascular cvcnts. The mean values of BPM + SD wcrc

Age. yrs SBP (01Ticc) nunllg

DBP (Office) nunllg

Diurnal SBP nun!ig

Diurnal DBP nunHg

Nocturnal SBP nunllg

Nocturnal DBP mmHg

Diurnal SBP load co;., >1-40/90)

Dîurnal DBP load (% >1-10190)

Nocturnal SBP load (% >120/MO)

Group I 11 7

6lJ±3

172±2S 83±15 I.J5±!8 80±l.J 144±21 80±13 55±39 23±34 83±29

Nocturnal DBP load (% >120/HOJ 45±40 Day-night SBP dilTerenee <mnHg -I. 7± 11 Day-ni ht DBP diffcrence nunHg l. l +7. tJ

* p<t1.05. ** p<O.OI OI Versus 02

Ciroup] n 7

71±5 l1tJ±2ö 82±13 117±21 68±9 110±27 63±8 19±31 4±8 35±.J5 8±17 -6.7±11 -.J.7+S.I

We coneinde that in elderly patiens m hcmodialysts thc office SBP. the diurnal and nocturnal BPM and thc BP load at the mght-Ume period predict and increase cardiovascular risk.

Key Words: Hemodialysis, blood pressurc monitoring. cardiovascular cvcnts

E19 EFFECTS ON AMBULATORY BLOOD PRESSURE OF DIARY, ACTIGRAPHY, AND ARBITRARY DEFINITION OF SLEEP AND A WAKE PERIODS. AJ. Peixoto Filho G. A. Mansoor and W. B. White. * University of Connectie ut Health Center, Farmington, CT.

The most accurate technique to define sleep and awake periods during ambulatory blood pressure monitoring (ABPM) is unknown. Patient diaries have generally been used in clinical trials, however electrooie activity monitoring is potentially the most accurate and objective metbod to define these periods. We studied the impact of using diary times of sleep and awake periods, wrist actigraphy determined sleep and awake times versus a standardized night and daytime period (10 PM - 7 AM) on BP data in 50 patients who underwent simultaneous ambulatory BP and activity monitoring (Basic Mini-motionlogger Actigraph, Ambulatory Monitoring, Ardsley, NY). Mean sleep time was 11:00 PM- 6:39 AM by diary and 10:58 PM - 6:40AM by actigraphy (P = NS). Analysis of varianee showed no statistically significant differences in mean BP, BP loads and awake-sleep SBP difference for the three methods of analysis. However awake-sleep DBP dilTerenee (mmHg) was significantly lower when standardized hours ( IOPM-7 AM) were compared to diary (15±6 vs 12±6, P=0.05). The limits of agreement were narrower for diary versus actigraphy than with diary versus fixed time eriod see table .

Diary-Actigraph Limits of

A wake SBP (mmHg) -2.2 to 2.1 A wake DBP (mmHg) -1.9 to 1.8 Sleep SBP (mmHg) -5.6 to 5.1 Sleep DBP (mmHg) -3.7 to 3.7 A wake SBP load (%) -5.6 to 4.7 A wake DBP load (%) -7.4 to 8.6 Sleep SBP load (%) -14.3 to 11 Slee DBP load % -9.1 to 9.6

Diary-arbitrary agreement

-2.8 to 3.1 -2.1 to 2.2 -9.9 to 3.9 -8.0 to 3.4 -6.4 to 6.4 -7.2 to 7.8 -19.9 to I 1.5 -22.4 to 9.7

The limits of agreement between diary and actigraphically detennined awake and sleep BP averages are smaller than the limits between diary and arbitrarily divided periods. Actigraphy can be used to objectively divide the awake and sleep periods.

ambulatory BP, activity monitoring Key Words:


ElS HOW MUCH NON-CALIBRATED THE SPHYGMOMANOMETERS ARE? D Mion Jr.(*), AMG Pierin and M Marcondes. Hypertension Unit, Nephrology Division, Univarsity of Sao Paulo School of Medicine General Hospita!, Sao Paulo-SP, Brazil.

We evaluate 524 sphygmomanometers: 351 (315 mercury manometers and 36 aneroid manometers) trom an Univarsity Hospita! and 173 (168 aneroid manometers and 5 mercury manometers) trom private doctor's offices. Results showed that 44% at hospita! and 54% at doctor's offices were noncalibrated. The magnitude of the non-calibration in the aneroid manometers was 4-6 mmHg in 18%, 8-12 mmHg in 19% and 14-20 mmHg in 22%. 35% of the mercury manometers were non-calibrated: a) 21% the meniscus of the mercury column was nol at the zero level; b) 14% there was difficulty of rising the mercury column; c) 7% the graduation on the scale was nol legible; d) 6% the filter at the top of the mercury column was clogged; e) 3% there was a lack of mercury in the reservoir. The bladder was damaged in 1 0% of the equipments at hospita! and 6% at doctor' s offices. In the tubes and intlating bulbs, it was observed: a) aging of the rubber in 34% (hospita!) and 25% (doctor's offices); b) leak and holes in 19% (hospita!) and 18% (doctor's offices); c) leak in the valve in 16% (hospita!) and 30% (doctor's offices). From the total of the sphygmomanometers evaluated, 64% presenled a damage that may interfere in the accuracy of blood pressure measurement. Therefore, the equipments need regular inspeetion and repair.

Key Words:

E20

blood pressure measurement, sphygmomanometers calibration hyperlension diagnostic.

REPEATABILITY OF ACTIVITY LEVELS ON TWO DAYS OF AMBULATORY BLOOD PRESSURE MONITORING: AN ACTIGRAPHIC STUDY. G.A Mansoor"'• E.J. McCabe and W.B. White"'. University of Connecticut Health Center, Farmington, CT. Physical activity levels influence arnbulatory blood pressure.

Hypertension researchers performing ambulatory BP monitoring attempt to minimize variability in physical activity by instructing patients to pursue their usual acti vities, and by performing such studies only on working days. We measured physical activity on two different days of ambulatory monitoring to assess its reproducibility. Sixteen hypertensive subjects, age 59 ± 11, (ll rnales and 5 females), underwent ambulatory BP and actigraphic monitoring for 24 hours on two occasions separated by 9 ± 2 weeks. Activity was measured on the dominant wrist by the Basic Mini-motionlogger (Ambulatory monitoring, Ardsley, NY), set at one minute epochs in the zero crossing mode. The resulting activity data was then analyzed based on a patient kept diary into awake and sleep periods. Activity levels were then calculated for each period per epoch (activity units/epoch). Overall twenty-four hour, and awake activity levels were similar between the two studies and the majority of differences (94%) between the two activity levels were within 2 standard deviations of the differences. Twenty-four hour activity levels on the two occasions correlated significantly with each other (r = 0.5, p = .04), but the limitsof agreement were wide (see Table). Twenty-four hour activity was inversely related with age ( r = -0.6, p = .OI ).

Activity Period 24 hour A wake Sleep

ActivÜ}l Levelslepoch Study A Study B 122±26 119±30 165±34 162±41 25 ±21 22± 18

meao djfference meao difference + 2 SD 24 hour A wake Sleep

2.6 -53 to 59 2.6 -81 to 87 2.8 -43 to 49

P value NS NS NS

These data mdtcate that although the actiVIty of the group remamed similar on two study days, there were substantial differences among individuals between the two studies. These data suggest that variations in activity may play a role in BP variability and may need to be accounted for in clinical trials.

Key Words: Activity, ambulatory blood pressure, monitoring

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E21 Sl:'rl'DIG Wl:TB LBGS CROSSED RAJ:SES BLOOD PRESSURE IN PATl:ERTS Wl:TB ESSERTl:AL BYPERTERSl:OR. P Narayan, A Notargiacomo, I Khatri, V Papademetriou*. Dept. of Veterans Affairs Medical Center, Washington, D.C. The purpose of the study was to assess the effect of different sitting postures on blood pressure (BP) • Diagnosis of hypertension (HTN) is usually made by measuring sitting BP in the clinic and

similar BP measurements are later used to regulate therapy. Thus while diagnosing and later regulating drug

therapy, it is important to know the effect of different sitting postures on

BP. We studied 20 patients with essential HTN (age=63±11 years, weight =186±39 lbs), who were off medications

for atleast three weeks and had a physical examination, EKG and laboratory tests. A mean of three BP readings was

first recorded with the patients sitting

with a back rest and legs uncrossed. The measurements were then repeated with

backs unsupported and legs crossed. Results:

N HR SBP DBP

Legs uncrossed 20 70±11 158±18 96±9 Legs crossed 20 75±11 171±20 102±13 p value 0.12 0.04 0.07 HR=heart rate. Conclusions: 1. Sitting

with legs crossed produced a significant rise in SBP. 2. DBP rose, though not

significantly. 3. There was no change in

heart rate. Thus sitting with legs crossed raises BP in hypertensives.

Key Words: Blood Pressure, Posture, Legs Crossed

E23 AMBULANCE SPHYGMOMANOMETERS ARE FREQUENTLY INACCURATE ~. RG Pirrallo, CE Grim*. Medica! College of Wisconsin,

Milwaukee, Wisconsin, USA. Critica! decisions are made based on blood pressure (BP)

measurements taken by emergency medica! technicians, thus we assessed the accuracy and reliability of 150 sphygmomanometers (SPHYG) used in our urban/suburban emergency medical services (EMS) system.

Each SPHYG was checked lor accuracy by connecting the aneroid manometertoa new, standard mercury manometer using a "Y" connector. Pressure was checked at readings of 60, 90, 120, and 200 mm Hg. The integrity of the device (leaking) was checked by intlating the culi around a colfee can to 300 mm Hg and measuring the pressure lost in one minute. Devices were determined to be inaccurate if the average of the absolute dillerences at each pressure deviated by more than 3 mm Hg. The device was determined to be unreliable (leaked) if it lost pressure greater than 15 mm Hg in one minute. Accuracy at 90 mm Hg was reported independently since both systolic and diastolic measurements of 90 mm Hg are clinically significant.

We found 28% (42/150) of the devices inaccurate at 90 mm Hg. The overall and 90 mm Hg average dillerences were ±5.95 and ±6.61 mm Hg, respectively. 62.7% (94/150) of the devices were unreliable (leaked). When eensidaring both accuracy and reliability at 90 mm Hg, a total of 72.7% (109/150) of the devices failed one or both of the criteria.

Previous literature reported 38% of EMS SPHYGs to be inaccurate. Although our 25.3 % was better than ethers have reported, our study also determined reliability which increases the potential maasurement error to 72.7% . lnaccuracy at 90 mm Hg was reported independently since at this level a systolic pressure can signify shock and a diastolic pressure, hypertension. Our study did not explore human error or the skill level required to perfarm this crucial maasurement and therefor represents a minimum error estimation.

This study suggests that an accurate BP maasurement may not be reliably obtained with 72.7% of the SPHYGs currently used in our EMS system. An inspeetion program of sufficient frequency to imprave accuracy and reliability has yet to be determined.

Key Words: Sphygmomanometer, measurement, blood pressure determination, emergency medical services, emergency medical technicians

POSTERS: Blood Pressure Measurement 107 A

E22 AFRICAN AMERICAN AND WHITE YOUNG ADUL TS HAVE A SIMILAR NOCTURNAL FALL IN BLOOD PRESSURE

AL. Hjnder!iter•, S. Girdler, K. Brownley, S. West, K.C. Light

Univarsity of North Carolina, Chapel Hili, North Carolina

Previous studies in adolescents and in hypertensive adults have demonstraled a blunted nocturnal !all in blood pressure in African Americans. Other investigations have not observed an ethnic difference in the circadian pattern of blood pressure. To further examine this phenomenon, we performed ambulatory blood pressure monitoring in 37 African American (AA) and 42 white (W) young adults with normal or marginally elevated blood pressure.

The African American and white subjects were similar in age (AA= 34±7, W=35±8 years, p=NS) and gender (AA=57%, W=62% female, p=NS). Average daytime, workplace, and sleep BPs were as fellows:

Daytime BP

Workplace BP

Sleep BP

AA

128±12/82±1 0

127±11/82±10

11 0±1 0/68±11

w

126±12/79±9

126±12/80±8

1 07±13/65±1 0

The dilterenee between average daytime and sleep blood pressures was 18±10/14±7 mm Hg in African Americans and 19±7/14±6 mm Hg in white subjects (p=NS lor difference).

These results do notsupport a clinically significant ethnic difference in the nocturnal !all in blood pressure in young adults without established hypertension.

Key Words: Ambula tory blood pressure monitoring, nocturnal blood pressure, race

E24

DAV TO DAV REPRODUCIBILITY OF BASAL AND PEAK HYPEREMIC FOREARM BLOOD FLOW MEASUREMENTS IN NORMAL ADULTS. S Venkatappa, P Jadhav, V Bhaktaram, J Turner, and U Thadani•. Univarsity of Oklahoma HSC, Oklahoma City, OK.

Forearm Blood Flow Maasurement using plethysmography is increasingly being used lor evaluation of

drug effects. We studied six normal non smoker subjects (25-32y) to investigate day to day reproducibility of forearm blood

flow at basal conditions and peak hyperem ia following prolonged ischemia. Subjects were studied on four consecutive days at BAM alter an overnight last. Baseline forearm blood flow measurements were made at constant room temp of 23.±.0.5°C in the supine position alter the subject had rested lor a full 1 5 minutes. lschemia was induced by complete venous and arterial occlusion at 50mmHg above systolic blood pressure for 5 minutes and peak hyperemie response was measured within 5sec of release of the arm cuff by reocclusion of the arm at 40mm Hg. Mean Baseline flow for each of the six subjects alter venous occlusion of the arm at 40mm Hg for 5 sec (cycle of five measurements) feil within a range of 1 . 84-4.95

ml/min/1 OOm I with coefficients of variatien between 14. 1-

24.27%. Mean baseline flow for the group was 3.15.±.0.98

ml/min/100ml with a coefficient of variatien of 18.1.±.3.44%.

Mean peak hyperemie response lor each of the six subjects feil

within a range of 30.4-51.2 ml/min/100ml with coefficients of

variatien between 13.79-38.36%. Mean peak hyperemie

response for the group was 37.38.±.5.85 ml/min/100ml with a

coefficient of variatien of 20.47.±.8.2%. We conetude that forearm blood flow maasurement using plethysmography varied

from day to day with large individual and group mean

coefficients of variation. These findings have important

implications when effects of medications are being evaluated

using forearm blood flow measurements.

Key Words: vascular, biology, blood flow

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lOS A ASH XI ABSTRACTS

E25 BLOOD PRESSURE PATTERN IN THE RECOVERY PERIOD AFfER CORONARY ARTERY BYPASS GRAFf!NG. D Duprez*, M De Buyzere, W Fonteyne, G De Backer, G Van Nooten, and DL Clement*. University Hospita!, Gent, Belgium

Arterial hypertension is a major risk for coronary artery discase (CAD). Coronary artery bypass grafting (CABG) impraves the prognosis of eertaio subgroups of severe CAD, but there is no information on 24 h blood pressure (BP) in the recovery periact postCABG. Therefore, the aim of the present study was to evaluate the ambulatory BP profile (SpaceLabs) at I and 14 weeks (w) after CABG. Fifteen patients (mean age 64 years) who remairred uncomplicated during 14 w follow-up after CABG were studied. Therapy remairred unchanged over that period. Data are given as office BP (mm Hg), day time and night time BP, variability and heart rate (beats/min). Office BP I w post CABG 14 w post CABG Systolic 127±12 135±16* Diastolic 71±9 76±11 Ambulatory BP Day time Night time Day time Night time Systolic 124±11 119±13 134±11** 129±10 Diastolic 74±9 69±10 82±11 ** 79±10 Systolic VC 10.0±4 9.5±3 11.8±3** 13.6±3* Diastolic VC 8.6±4 7.8±3 9.7±3* 11.2±3* Heartrate 78±14 74±15 72±12 69±11 ** p<O.Ol, *p<0.05 versus Iw, VC= variation coefficient (%) In the recovery period after CABG the BP pattem showns an increase in office systolic BP. During 24 h ambulatory BP recording, day time systolic and diastolic BP are significantly increased may be due to the possibly increased exercise capacity after CABG. Moreover, systolic and diastolic BP variability increased as well.

Key Words: ambulatory blood pressure, coronary artery bypass grafting, blood pressure variability

E27

BLOOD PRESSURE (BP) EARL Y MORNING RISE AND LEFT VENTRICULAR MASS AND DI MENSlONS P Codispoti. M Muscolo. S Bravo. S Angotti. L Fcderico. V Pecchioli, COlS Damiani. G. Gcrmano·* l Clinica Medica & C)Biometria, University ·'La Sapicnza", Rome, ltal} OBJECTIVE Cross-sectionat and longitudinal evidenccs suggcst that the organ cardiac involvcment of hyperlension may depend nat only on BP as time span arithmetic mean but also as magrtitude of its changes. Among these. BP early moming surge occurs with the longest linear interval. The aim of this study \\as to investigate wether the RANGE - the interval difference between maximal and minimal values - and the "SPEED'' - straight line slope that represents BP increase in thc unit of time - both singled out by F ourier analysis, could influenee left ventricular morphology determined by echocardiography. DESIGN AND METHOOS 344 patients (aged 47 ± 13yrs) with mild to moderate hypertension, never previously treated. underwcnt a 24-h ambulatory BP morlitoring (DA YTIME 7amllpm: NIGHTTIME llpm-7am: BP noctumal FALL) and an echocardiography study to asscss left ventricular anatomical parameters, categorizing: relative wall thickness (RWT) and mass index (L VMI) within NORMAL lirnits: L VMI normal but RWT increased (CONCENTRIC REMODELING); L VMI incrcased and RWT normal (ECCENTRIC HYPERTROPHY): LVMI and RWT increased (CONCENTRIC HYPERTROPHY) RESULTS

CONCLUSIONS Patients with highest left ventricular pattem values showed no difference on circadian BP parameters but braader and faster BP rise shape suggesting that these ulterior measurements of peri-awakerting BP behaviour will add information on the prediction of target organ damage.

Key Words: circadian rhythm, left ventricular hypertrophy.


E26

AFTERNOON BED REST RE DUCES BLOOD PRESSURE LIKE AFTERNOON NAP. Waisman G* Magi M, Galarza C.R*, Alfie J, Mayorga LM, Cámera M 1*. Hypertension Unit.Hospitalltaliano. Buenos Aires. Argentina. Objective: To campare blood pressure level between bed rest and nap in the aflernoon. Design and methods: We measured ambulatory blood pressure (mean and total area under the time cu!Ye of SBP and DBP) handling a Del Mar IV. Fifly-nine mild hypertensive unmedicated subjects (age 53±14 yr.) were prospectively instructed tosleep in the aflernoon (n=22). to rest in bed without sleeping (n=17) or to stay active (n=20) in the postprandial period. Results were lesled using repeated measures ANOVA and Bonferroni I-tests. Data are reported as means±SD. Results: There were nol dilterences between groups neither lor nocturnal SBP (131±16, 131±25. 127±18 mmHg; p NS) nor lor nocturnal DBP ( 84±7.8, 83±13, 81±7 mmHg; p NS). Patients who slept in the aflernoon showed similar SBP (134±26 vs 138±20 mmHg; p NS) and DBP (80±9.8 vs 83±9.5 mmHg: p NS) than patients who rested without sleeping, but lower SBP (134±26 vs 149±16 mmHg, p < 0.001) and DBP (80±9.8 vs 92±8.5; p < 0.001) than patients who stayed active. Patients who slept in !he aflernoon showed similar SBP and DBP, and those who rested without sleeping showed significant higher SBP (p<O.OS) and similar DBP compared to nighttime values. Conclusions: Nat only sleep but also rest without sleeping in the aflernoon decreased blood pressure. Our resulls also suggest that blood pressure reduction is nat dependent on the time of the day, since DBP during aflernoon sleep or rest was sirllilar than DBP during nocturnal sleep.

Key Words:

E28

Ambulatory blood pressure monitoring, aflernoon rest, aflernoon nap

A NEW GRAPHIC APPROACH TO THE EV ALUA Tl ON OF AMBULA TORY BLOOD PRE SS URE (BP) MEASURING DEVICES. Dllllliani S, (•) Muscola M, ( •) Angotti S, ( •) Uravo S, ( •) Codispoti P, (•) Fedcrico L, ( •) Üi..~anó G*. Riometria & ( ~) I Clirlica A-1edica, University "La Sapienza ", Rome, ltaly.

Regan.ling to tcsting:-; and analyses for Lhc validation of BP ambulatory monitors it is uscfuJ to have at onc's disposal a broad spreclum of mcthodologics. Aim of this study is to suggest a ncw graphic crik'lion. It is suitablc for camparisous hetween an autornaled device and a rnercury colwnn ~"Phygmornanorneter canied out by two observers. "fbe method is based on thc ditTerences among dcviccs {D) and obscrvcrs {A, B) and between obscrvers (Illand & Altman, LANCET 1986;i: 307-310)

We cvaluatc-d thc OSCIU.n· (F!GI-ltaly) an intcgratcd oscillrnnetric ambulatory BP recordt->r, with scqucntial, samc arm measurcmcnts, in a large, heterogeneaus population ( 100 subjccts, 52 mal es, 48 fcmalcs; rncdian agc and range: rnales 44.5/19-79[] females 54.0/19-74; sphygmomanometric readings: systohc from 90 nunHg to 260 mmHg-<iiastohc from 58 mmHg to 130 mmHg). '!he graphic enclosed considers as reference, that is zero, the device. In ordinate, thcre are D-A ditTerences showed with • and thosc l)..B with •; in abscissa, the patients. 'Ibc segment that joîns the symbols exemplifics obscrvers diftert..'Ilcc.''i. In other words, thc gmphic depiets simultaneously, patient by patient, thc discrepancies D-A_ D-B, A-H and thcrefore shows, "ictu oculo", all data, thc over- and underestimates among D, A, and B. It allows the construction of tablcs, the calculation of avcrages and standard devtations. 1he graphic was compieled with confidencc intervals here nol drawed, and also liimted to 10% of expcrimental data, for the reduccd dimensions. ,---~~~-----~-~-··

i 15,---------------------------------,

I 10

I .

-5

-10

-15 '----------------------------'

~.~~~~~~~~~~~~~~~

Key Words: BP ambulatory mortitoring, validation.

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E29

INDEPENDENT ASSOCIATION BETWEEN PERSISTENGE OF PRESSURE OVERLOAD AND VENTRICULAR ARRHYTHMIAS IN HYPERTENSION. G Schillacj, P Verdecchia, C Borgioni, A Ciucci, N Sacchi, R Gattobigio, C Porcellati. Dept. of Cardiology & Medicine, Silvestrini Hospita!, Perugia,

and Città della Pieve Hospita!, ltaly.

To test the independent association between persistent pressure overload over the 24 hours ('nondipping' pattern) and ventricular

arrhythmias in hypertension, 126 never treated, uncomplicated

essential hypertensive patients (83 men, age 46±11, BP 161/102 mmHg) underwent 24h ambulatory BP mon~oring, 24h ECG

mon~oring and M-mode echocardiography. Ventricular premature

beats (VPB) were found Lawn 0-1 Lawn 2-4 in 89 subjects (71%). n-79 n-47

The number of. VPB Age, years 4s (9) ss· (10) showed a S1gnof1cant Smokers, % 34 4S

association (all P<0-05l Clinic SBP/DBP, mmHg 1S91103 164/100 Wllh age (r= 0.25) and 24h SBP/DBP 144/94 150./93

LV mass (r= 0.24), and Day-night%SBP/DBPfall 10/14 s•110·

a negatwe assocla!lon LV mass index, gxm' 127 (37) 147' (38) wrth day-mght SBP/ DBP !all (r=-0.311_0_24). ~erum K', mmolil 4.1 0.4 4.2 0.4

No correlation was p<0.05 vs Lawn 0-1. Mean (SD).

found w~h absolute BP values (clinic and 24h). By mu~iple linear

regression we lesled !he independent relation of saveral variables to lhe number of VPB; a blunted day-night SBP reduction (p <0.003), an increased LV mass (p<0.03) and an older age (p<0.04) predieled a higher number of VPB. In a mu~iple logistic regression analysis, we lesled the delerminanis of complex ventricular arrhythmias (Lown ;"2 vs Lown 0-1 ). In this model, a Lown grade ;"2

was predieled by an age >60 (odds ratio 10.6, 95% Cl 2.4-46.7) a day-night SBP reduction <10% (odds ratio 2.8, 95% Cl1.2-6.9), LV

hypertrophy (odds ratio 2.7, 95% Cl 1.0-8.1) and 24h pulse

pressure (odds ratio 1.05, 95% Cl 1.00-1.1 0) Gender, serum K',

smoking, clinic BP and 24h DBP did nol enter the equation. Therefore, in untreated hypertensive patients, a persistent BP

overload over 24 hours ('nondipping' pattern) is associated with

ventricular arrhythmias. This association is independent of age,

ayq,r§i!W&8's:serum K', smoking status and lelt ventricular mass.

E31

Hypertension, arrhythmias, LV hypertrophy, ambulatory BP mon~oring, circadian variation.

CONFIRMA TION OR EXCLUSION OF HYPERTENSION BY AMBULATORY BLOOD PRESSURE MONITORING A ST ATISTICAL APPROACH CR Moore LR Krakoff', RA Phillips* Hypertension Seclion. CV Institute. Mount Sinai School of Medicine. New York . NY.

Criteria for the diagnosis or cxclusion of hyperlension using

ambulatory BP monitoring (ABPM) have nol been agreed upon. This study was designed to provide a statistically-bascd guide for using results of ABPM to resolve this issue. To gencratc this information.

we uscd a database of 228 untreated subjects ( 13 5 men. 9J wamen.

mean age: 45 yrs) referred over the past 7 years for evaluation of borderline prcssure (mcan office BP: 148/92 mmHg. SD:+/-18/12 mmHg). In this population, the paoled standard deviation (SD) of systolic and diastolic ABPs was 13.8 and 11.6 mm Hg. respccti\cl) Using the paoled SD, we calculated thc probablity that a pallent's BP falls within the hypertensive range (>140/90). The 95% confidencc interval for each subjeet's ABPM was also detcnnincd. Shown bclo\\ is the probability curve for systolic ABP when numbcr of ambulatol}

readings obtained ~40. In this example, if the average systolic ABP is 137 mm Hg, then there is only a 10% probability thatthc patient's 'truc' BP is actually in the hypertensivc range. lfthc systolic BP is 143, there is a 90% probability that the patient is hypertcnsivc. Th is approach may be useful for clinical decision making and for thc design of clinical trials.

100

~ 80 >: ~ 60 :c .. 40 .Q

e c.. 20

0

"' "' ,_

"' ::;: "' "' ,_

"' "' "' "' '<t '<t '<t

Average Systolic ABP(mmHg)

Key Words: ambulatory blood pressure, statistics, decision analysis


E30 CARDIOVASCULAR RESPONSE TO THE MENSTRUAL CYCLE: ETHNIC SIMILARITIES AND DIFFERENCES. GD James*, RM Marion, PA Broeqe, and TG Pickerinq*. Cornell University Medical Colleqe, NY, NY 10021.

The pllrpose of this stlldy was to compnre bet•>een black (B) and whi te (W) wamen, the effects

of the menstntal cycle (MC) on the di urnal varia

ti on of blood pressLtre (BP), Llrinary aldosterone (UA), potassi1un (UK) and cortisol (UC) excretion and PRA. The subjects of the study were 13 B (aqe=37.22:_7.4 yrs.) and 11 W (aqe=37.42:_3.7 yrs.) normotensive, working wamen with normal MC's. AmbLtlatory BPs and timed Ltrine samples were collectedat work (Wo) (11AM-3PM), home (H) (approx. 6PM to 10PM) and durinq sleep (S) (approx. 10PM-6AM) in the follicular (F)(day 82:_1) and luteal (L) (day 222:_2) phases of the MC, Blood for PRA was dra1m in the morninq prior to the BP hook-Ltp, Camparisens between B and W showed that the levels and chanqe of systolic BP at Wo, HandS over the MC were similar, as were diastalle BP levels and

changes at Wo and dllrinq s. W, however, had a drop of diastalle BP at H (78 to 73, p<.OS) while

B had no chanqe ( 78 to 78) . W tended to have hiqher UA over the MC than B, particularly at Wo (p .OS) >ihich was consistent >V'ith their hiqher levels of UK (p<,OS), B tended to have lo>ier and less variable UC intheL than W (p<.03), Finally, the PRA of Ww-as consistently higher than B over the MC (p<,OS), PRA increased from F toL

in both qroups ( 1. 7 to 2. 9 ng/ml/hr (W); , 87 to 1.7 nq/ml/hr (B); p<.OS). There >V'ere no ethnic differences in the chanqes of UA, UK or UC over the MC. These data suqqest that >ihile there are some fLmdamental biol~Jical differences bet>ieen B and W, the effect of the MC on BP and the horrnanes examined is similar in both groups,

Ke WortWpported by NIH grant HL47540 y ambula tory blood pressure, menstntal

cyclP, ethnic differences

E32 PREDICTION OF CIRCADIAN BLOOD PRESSURE

PATIERN BY CLINIC OR PREIPOST SLEEP POSTURAL

BP. SJ Rosansky *, MR Littlejohn, KN Vo, JR Rosenberg, K

Jackson, SJ Menachery, Medica! Service Dom VA Hospita!,

Dept. of Medicinc, University of SC School of Medicine,

Colurnbia, SC. We reported that posture may be a determinant of

circadian BP changes [i.e. decline of BP with reeurnbent

preparatien for sleep (PTS) and an increase in BP when rising in

thc moming A W)]. In order to test this hypothesis in 21

hypertensive paticnts (15 black and 6 whitc), wc rneasured BP

changes PTS and A W utilizing SpaceLabs 90207 monitors

which patients used to record PTS, AW and 24-hour BP (3

rneasures per hour). Prior to 24-hour BP monitoring, postural

BP changes frorn recumbent to standing mid-aftemoon were

measured in the clinic. Although there was a significant decline

in diastolic BP PTS, and an increase in tbc clinic (recumbcnt to

standing diastolic BP), neither change prcdictcd circadian

diastolic BP change as measured by the difference between day

(0700-2300) and night (2300-0700) values (by linear regression

P > 0 3 for all three) DIASTOLIC BP PTS AW Clinic Day/

+SE Night

Recumbent 94.4 ± 96.1 ± 98.5 ± 90.0± (Night) 2.7 2.8 0.9 1.7

Standing 105.0 ± 103.3 ± 105.8 ± 97.7 ± (Da)iime) 2.3 2.8 1.7 1.7

Delta± SE 10.6 ± 7.2 ± 7.2 ± 7.7 ± 2.4 3.7 1.3 1.4

P-value <.OOI .062 <.OOI .003

In conclusion, although there ts a s1rn1lar rnagmtude of postural

diastolic BP change going to bed, getting out of bed, and going

frorn reeurnbent to standing in the clinic, these changes are not

useful to predict rncan day/night circadian BP differences.

Key Words: Circadian BP, Posture, Prcdict

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E33 AMBULATORY BLOOD PRESSURE MONITORING IN NORMOTENSIVE AND HYPERTENSIVE OBESE SUBJECfS. L Maldonado, J. Topouchian, A.M. Brisac, J. Raison, L.A. Providencia, M. Safar, and R. Asmar*. Institut de Recherche et Formation Cardiovasculaire, Paris, France - Hospitais da Universidade de Coimbra, Portugal.

The relationship between overweight and hyperlension is a discussed topic in the current literature. Besides the physiopathologic concepts involved, the main reasans for such a discussion are related to obesity definition, patients selection, cuff size and reeruitment of patients based in casual BP measurements. The purpose of this study is to evaluate the circadian blood pressure profile in patients with obesity, and to campare it to those observed in matched normal weiglit hyperlensive and normotensive subjects. The study was carried out in 92 untreated su~ects (33 men and 59 wome'!z mean age 43.12 ± 11.84.years). Body mass index (BMI) (Kglm ) was used toselect obese patients (BMI> 30 Kg I m2). They were healthy normotensive obese (n = 28), hyperlensive obese (n = 18), healthy normal weight (n = 28) and normal weight hyperlensive patients (n = 18). Arobuiatory blood pressure recordings were performed noninvasively using a autornaled apparatus with measurements performed at 15 minutes interval over 24 hours. Mean values calculated from the day time, night time and the full 24 hours were used for statistica) aualysis and circadian variability was assessed on the basis of the absolute standard deviation (SD) and from the day-night difference, evaluated in each subject. Obese hyperlensive patients had a less marked systolic fall in blood pressure at night than the normal weight hyperlensive patients (9.09 ± 6.25% versus 12.86 ± 4.3 %; p < 0.05). In what concerns to standard deviation variability of blood pressure, it is significantly higher in hyperlensive and in obese patients. This study shows that obesity does nat, for itself, impose major changes in circadian blood pressure pattem, although may have influence on BP variability. However, when obesity is associated with hyperlension nat only BP variability is changed, but the night fall in BP is also impaired. These findings are presumably related to humoral and hormonal changes involved in the patophysiology of hyperlension, in obese patients.

Key Words: arnbulatory blood pressure monitoring - obesity -circadian variability- blood pressure variability

E35 DECISION-MAKING IN HYPERTENSION: INCREASING ROLE OF AMBULATORY BLOOD PRESSURE MONITORING (ABPM). E....Rl!!nl!s. R. Sánchez*, Y. Piotquin, M. Amoit, P. Rodriguez, M. Diaz, A. Villamil, H. Baglivo•. Grupo Argentino para el Estudio de la Hipertensión Arleriai (GAEHTA), Buenos Aires, Argentina.

In order to delermine the intlucnee of the ABPM on the clinical decisionmak.ing process, a multicentric prospective study was carried out in patients consulting at Hypertension Centers. Patient's blood pressure (BP) measurements were obtained sequentially at the clinic (CBP), at home (HBP) and with ABPM (ABP) under the same conditions of treatment, according to standard clinical procedures. Each researcher selected a decision based on BP data in three steps along the study: with CBP (first decision), plus HBP (second decision) and plus ABPM (third decision). Options considered in steps two and three were dichotomously applied: decision could be the same or different to the previous one. Final decision depended on researcher's judgment. According to the agreement between CBP and ABPM data, and using as a cut-off BP limits 140 and/or 90 mm Hg (systolic, diastolic) patients were classified as normotensive (NT), hyperlensivo (HT), white-coat hyperlensivo (WCHT) if only CBP was high and occult hyperlensivo (OHT) if only ABP was high.

A number of 137 patients were studied, 81 women, age 57 ± 14 years, 79 (58%) under antihypertensive treatment. CBP: 150± 17 I 89±9 (from a mean of 8 BP measurements) was higher (p < 0.00 I) than HBP: 144± 16 I 86±8 (from a meao of 6 BP measurements) and also higher than ABP (day-time average): 139±14 I 86±9 [mm Hg, systolic/diastolic BP). The correiation index between different methods was: CBP-HBP r: 0.57 I 0.40, CBP-ABPM r: 0.46 I 0.34 and HBP-ABPM r: 0.39 I 0.33 (systolic/diastolic). In a subgroup of 78 patients Ieft ventrienlar mass index (LVMI) was available and the correlation index ofLVMIsystolic BP was: for CBP r: 0.27, for HBP r: 0.24 and for ABP r: 0.37. Aiong the study the first decision remained invariable in 61 subjects (45%), and the third decision was exclusively determinant in 35 subjects (26%), but as ABPM confirmed or modified the second decision, hence its total gravitation in the final decision was 55%. Change in decision was found to be less probable when diastolic CBP was> 100 mm of Hg (16% VS. 54%, x'. p: 0.003). Classification 1:ndings by CBP and ABP were: 20 NT (15%), 67 HT (49%), 12 OHT (7%) and 38 WCHT (28%). HBP was nol useful in order to identify the OHT. In 37% of the patients under antihipertensive treatment the decision changed after ABPM.

lt is concluded that in usual medica! care in hyperlension centers, the data from ABPM modify the clinical conduct in a great proportion of patients, mainly in those whose diastolic CBP is~ 100 mm Hg. The design ofthe study, retlecting the clinical practice, stresses the increasing role of ABPM on clinical decisionmaking, due to the discrepancies between CBP and ABP measurements and the researchers' preferenee for the Jatter. Key Words:

Arobuiatory blood pressure monitoring. Clinic blood pressure, Home blood pressure.


E34 REPEATED MEASUREMENTS OF NON !NV ASIVE AMBULATORY BLOOD PRESSURE : DISTINCfiON BETWEEN REPRODUCffiiLITY AND THE PROPER EFFECf OF PLACEBO. & Asmar•, S. Boutelan, M. Chaignon, J. Guedon, J. Topouchian, J.M. Mallion, M. Safar. Höpital Broussais, Paris , France.

Non invasive arnbulatory blood pressure (BP) is more reproducible and less affected by placebo than the clinic BP measurements. Most of these evidences were obtained in smal! groups of patients or from a parallel group study design which did nat allow to analyse separatly the reproducibility from the "specific" effect of placebo. In this study, 34 hyperlensive outpatients were randomized after 4 weeks preselection period in 2 groups cross over study design : one group received placebo for 4 weeks while the other farm the control group (reproducibility). Then, they cross-avered treatment foranother 4 weeks. Clinic and arnbulatory BP were measured befare the randomization and at the end of each peri ad, using mercury manometer and 24 hour non invasive arnbulatory BP monitor. Placebo showed a significant rednetion in systolic and diastolic clinic BP (- 3.4 ± 13 mmHg and- 3.6 ± 8 mmHg respectively; P < 0.05), but not in 24 hour, daytime and nightime BP. Circadian hourly curves of BP and heart rate were virlually superimposable. In the 13 placebo responder patients selectedon the basis of clinic BP, placebo decreases clinic BP and also reduces systolic and diastolic ambulatory BP mainly during the day period (-5.2 ± 6.2 mmHg and- 4.8 ± 7.8 mmHg; P < 0.05). This effect is specific to placebo administration since the measurements without treatment did not show any significant difference. The comparison with the non placebo responders showed a lower baseline values of ambulatory systolic BP reearcled during the 24 hour, daytime and nightime in the placebo responder group. These results indicate that 24 hour arnbulatory BP average is nol affected by placebo in group of patients but that a placebo effect occurs mainly during the daytime in the clinic placebo-responder patients ; the BP rednetion is related toa specific effect of placebo. Although, this study clearly points out the necessity to include placebo and arnbulatory monitoring in the therapeutical and pharmacological trials.

Key Words: Blood pressure, placebo, reproducibility

E36 SIMUL TANEOUS AND SEQUENTIAL SAME-ARM MEASUREMENTS IN THE VALIDATION STUDIES OF AUTOMATED BLOOD PRESSURE (BP) MEASURING DEVICES. R Livi, L Teghini, S Cagnoni, and PT Scarpelli. lnstitute of Clinical Medicine IV, Postgraduale School Nefrology and Department of Electronic Engineering, Univarsity of Florence, ltaly.

Bath the AAMI and the BHS guidelines tor the validatien studies of automated bp measuring devices recommended in their initial versions to campare simultaneous same-arm bp readings taken by the device being tested and by trained observers with a mercury sphygmomanometer. In 1993, the BHS protocol adopted sequentia! measurements and modified final grading criteria to accomplish with the expected higher device-observer disagreement This choice was justified because the rapid datlation rate of many devices did nol permit accurate simultaneous readings. Simultaneous and sequentia! measures have been used in the validatien study of a new oscillometric ambulatory bp monitoring device (Daypress 500, Neural lnstruments, ltaly). The mean absolute ditterences between abserver's consecutive (within 1 minute) measures (255 observations) were 3.4 (range 0-20) and 2.5 (range 0-12) mmHg tor systolic (SBP) and diastolic bp (DBP), respectively. SBP ditterences were inversely related to heart rate (r = -0.22, p<0.001 ). As expected, device readings

were closer to the simultaneous than to the preceding or the following abserver's measurement. However, bath sequentia! and simultaneous readings leaded to the same final evaluation (A for DBP and 8 for SBP), provided that the appropriate grading criteria were applied for each method.

Key Words:

blood pressure, measure, autornaled device validatien

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E37 DIFFERENT HAEMODYNAMIC PATTERNS IN WHITE COAT HYPERTENSION F. Colombo, E. Perilli, M. L. Or1andi, M. G. Merati and A. Libretti lntemal Medicine, University of Milan, L. Sacco Hospita!, Milan

The clinical meaning of White Coat Hypertension (WCH) is still debated very well, moreover the haemodynamic parameters of these subjects had not been sufficiently studied. The aim of this study was to evaluate the haemadynamie parameters, cardiac index (Cl) measured in llmin/m2 and the index of peripheral vascular resistance (SVRI) measured in dyne · sec/cm5 • m2, analysed by impedenee cardiography (NCCMO, BOMED Medica! Man-USA). Therefore 30 patients with WCH and 30 patients with Established Essential Hypertension (EEH) were studied. WCH patients were defined as subjects with arterial blood pressure ~ 140/90 mmHg, determined in sitting position as the average of at least 3 separate sets of three measurements, and with diurnal (7 a.m. 10 p. m.) ambulatory arterial blood pressure mean values less than 134/87 mmHg. EEH patients were defined as subjects with blood arterial pressure ~ 140/90 mmHg during the first visit and with diumal ambulatory arterial blood pressure mean values more than 134/87 mmHg. A control group of 30 normotensive subjects was selected. The two groups of hypertensive patients and the control group were similar in terms or sex, age and smoke habits. WCH subjects were also divided into two subgroups according to their ambulatory blood arterial pressure mean value at first hour: a group A with PA s 134/87 mmHg and a group B with PA> 134/87 mmHg. The a:~alysis of the three groups revealed no significant variations in C.l. Subgroup B of WCH patients revealed increased peripheral resistance as compared to sub-group A (2420±391 vs 2035±180 dyne · seclcm5 · m2; p < .05), but similar as compared to EEH subjects. The different haemodynamic conditions detected in WCH patients suggest the existance of functional or structural vascular changes with increased peripheral resistance. This finding might indicate that WCH is not an innocent clinical condition.

Key words: White Coat Hypertension, Established Essen-

tlal Hypertension, Haemodynamic pattems

E39

Ambulatory Blood Pressure Monitoring in the Eldery. L.S. Costa*, J.C. Tress, C. Drumend Neto, J. Mail Filho. Santa Casa da Misericórdia, RJ - LABS, Rio de Janeiro,

Brazil.

Objective: A four year fellow up study on 6000 subjects that since november 1991 to december 1995 underwent Ambulatory Blood Pressure Monitoring was performed. The aim of this study was to evaluate our group of eldery hyperlension patients, more than 65 years old and taking antihyperlensive drugs. Design: Ambulatory blood measurements where achieved by ambulatory blood pressure recording using the Takeda A&D. The device was programmed to provide a blood pressure measurement every 10 minutes during awaketime and every 30 minutes during sleep-time. The pacients where separated in two groups: hyperlensive and normotensive patients, using casual measured. Results and conclusions: Blood pressure variability has been increased and there are some evidences that bath white coat hyperlension and the white coat effect are more prevalent in older subjects. The rise in blood pressure in the early morning in hyperlensive patients has been referred to as morning surge. This fact is associated with the aceurenee of cardiovascular events. There is a streng significant relation between the morning systolic blood pressure increase, the white coat hyperlension, blood pressure variability and target organ damage, suggesting the prognostic imparianee of systolic blood pressure in the

eldery. Key Words: Blood Pressure, Ambulatory Monitoring,

Eldery.

POSTERS: Blood Pressure Messurement 111A

E38

IMPACT OF AMBULATORY BLOOD PRESSURE ON LEFT A TRIAL SIZE IN UNCOMPLICATED HYPERTENSION A. Alfieri, M. Galderisi*, A. Fakher and 0. de Divttiis. Clinical Methodology, "Federico Il" University ofNaples, Italy

An associatioo between left atrial (LA) enlargement and risk of stroke has been recently documented. Aim of our study was to delermine the predietors of LA size in systernic hypertensioo which is aften associated to LA enlargement. The study populatioo included 125 subjects (72 men, 53 wamen, mean age 46 years) divided into 2 groups: 22 normotensives and 103 hypertensives (office BP > 140/90 mmHg). Exclusioo criteria were corooary artery and valvular disease, coogestive heart failure, diabetes and use of cardiac medicatioos. The subjects underwent M-mode echocardiograrns oo the same day as 24-h ambulatory BP monitoring. LA dimensioo was measured at end-systole and the ratio ofthe LA dimensioo to the aartic root (LA/AO) was calculated. Left ventricular (LV) mass was determined by Penn cooventioo and indexed for height (L VM/Ht). Average 24-h BP, average daytime BP (7am-llpm) and nighttime BP (Ilpm-7am) were determined. The 2 groups were camparabie for sex prevalence, heart rate and body mass index (BMI) with an older age (p<0.005) in hypertensives. They also had higher average 24-h ( either systotic or diastatic) BP, daytime and nighttime BP (all p<O.OOOI). LA size, LA/AO and LVM/Ht were increased (all p<O.OOOl) in comparisoo with normotensives. By a multilinear

regressioo analysis, BMI (Jl coefficient =0.32, p<O.OO!), average

nighttime diastatic BP (Jl=0.24, p<O.Ol) and male sex (fl=0.21, p<O. 0 I) were independent determinants of LA size in the paoled populatioo. After removing the effect of these variables, parrial correlatioos of age, average daytime BP and L VM/Ht to LA size were not significant. We cooclude that average nighttime diastatic BP is a powerful marker of LA enlargement in uncompticated systernic hypertensioo.

Key Words:

Ambulatory blood pressure, Echocardiography, Heart atrium

E40 BORDERLINE HYPERTENSION: EVALUATION BY AMBULATORY BLOOD PRESSURE MONITORING. E. Lima Jr.·, C.L.P. Cunhà. Federal University of Paraná; Curitiba -Paraná - Brazil

To assess blood pressure profile in Borderline Hypertension we studled 30 patients (BH group), 14 rnales and 16 females, mean age 41±14 years. They were compared to: Normotensive Control group (NC group: n = 26, 13 rnales and 13 females, mean age 46±11 years), Susteined Hypertension group (SH group: n = 20, 8 rnales and 12 females, mean age 43±11years) and Controlled Hypertension group - CH: n = 20, 6 rnales and 14 females, mean age 54±12 years). All of them were evaluated by 24 hours Ambulatory Blood Pressure Monitoring. The following items were analysed: heart rate, systolic and distalie blood pressore (minima!, maxima!, mean, standard deviation, amplitude, pressure load and noctumal descent), pulse pressure and peak pressure time. Vigil and Sleep data were checked. BH group showed higher blood pressure levels than NC group in all the measurements: minima!, maximal and mean values of systolic and diastolic pressure, during vigil and sleep (p<0,05). BH group's noctumal descent was larger than NC group's in absolute values (p<0,05), but not in percent. BH group's pressure variability, as assessed by standard deviation and amplitude, showed larger values than NC group's at vigil (p<0,05), but nol during sleep. BH group had lower pressure values than SH group in all the items (p<0,05). SH group had a smaller noctumal descent than BH group regafding diastalle blood pressure (p<0,05). Camparing to CH group, BH group had lower measurements in most of the pressure parameters (p<0,05). Systolic and diastolic pressure load were smaller at BH group than at CH group, both at vigil and sleep (p<0,05). BH group's pressure variability was also smaller than CH group's (p<0,05). In conclusion, patients with Borderline Hypertension, as evaluated by Ambulatory Blood Pressure Monitoring, showed higher pressure values than normotensive persons and lower than hypertensive patients. Also borderline hyperlension patients. Also, borderline hyperlension patients had a larger pressure variability than normotensive persons at vigil, but similar standard deviation and amplitude during sleep. Key Words: Borderline Hypertension, Abulatory Blood Pressure Monitoring, Systemic Arterial Hypertension.

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E41 APPLICA TION OF A NEW NONINV ASIVE HEMODYNAMIC ANAL YZER IN THE DIAGNOSIS AND TREATMENT OF HYPERTENSION; J. Kabai*; Noninvasive Hemodynamic Diagnostic Center for Hypertension and Stress Medicine, Great Falls, V A

A Noninvasive Hemodynamic Analyzer was developed by using aigorillunic computation of Pulse Wave Sequentia! Analysis. This method can be used onder any circumstances and requires no individual baseline calibration. A full Hemodynamic spectrum can be calculated with the following parameten;: Cardiac Index, Systemic Vascular Resistance, Stroke Index, o/oEjection Fraction, Acceleration Index, End Diastolic Index, Left Cardiac Work Index, Oxygen Delivery Index, Maximal 0, Consumption Index and Pulmonary Wedge Pressure. Measurement time is short cao be done in continuous intervals. Accuracy is comparable to other noninvasive methods.

The Analyzer cao be applicd for a wide variety of clinical conditions, such as llypertension, congeslive heart failure, pro-, and posl-<lperative evaluations in rest and during exercise.

Two clinical cases of Hypertensive Disease are presenled llere before and aller treatmenl. The main llemodynamic sequcnces are presenled in the following way: I. Meao Artcrial Pressure-Cardiac Output-Systemic Vascular Resistance and 2. Preload-Myocardial Contractility-Afterload.

Thus, the hemodynamic anaiysis of each patients cao be easily correlated with the llemodynamic properties of the seiected medication(s). This new Noninvasive Hemadynamie Anaiyzer assures a more etiological approach in the trealment of llypertension.

Key Words:

E43

Noninvasive Hemadynamie Analyzer, Hemodynamic ParametciS

AMBULATORY BLOOD PRESSURE MONITORING BUT NOT OFFICE BLOOD PRESSURES CORRELATE WITH THE HORMONAL RESPONSE TO DIURETICS. P Trenkwalder*, S Mann*, JH Laragh*, JE Sealey*. Mediz. Klinik I, Klinikum Grosshadem, University of Munich, Germany and Cardiovascular Center, Comell University Medica( College, New York, NY.

Treatment of hypertensive patients with diuretics results in counterregnlatory changes of the renin angiotensin system. In this study we tried to assess the relationships between changes in office blood pressure (OBP) or ambulatory blood pressure (ABP) and baseline values or changes (~)in plasma renin activity (PRA) and plasma prorenin (PRO) during treatment with diuretics.

Thirty-one elderly hypertensives (meao age 79±6 years, OBP ~ 160/ 95 mmHg) were treated with hydrochlorothiazide (25-50 mg)/triamterene (50-100 mg) for 6 months. Measurements ofOBP, 24-hour ABP (Spacelabs 90 207), PRA (enzyme kinetic assay) and PRO (total renin minus PRA after limited protealysis with trypsin) were performed befare and after treatment. Regression analyis was performed of changes (absolute and %) in OBP or ABP with changes in PRA or PRO, and baseline PRA or PRO. OBP feil from 194±21/100±8 to 166±24/87±15 mmHg, 24-hour ABP from 161± 16/86±9 to 144±15177±8 mmHg; PRA increased from 1.8+1.8 to 2.9±2.0 and PRO from 15.9±10.5 to 24.5±14.7 nglmllhr {P<0.05 for all). 'l•hough there was no correlation between ~OBP and either ~RA o• nPRO, ~ pasiti.ve relationship was observed between ~pand ~RO (r=0.56; p=0.01), btit oot LWRA. The correlation between ~p and ~RO persisled after including baseline PRO as covariable. In addition, ~P, but oot ~OBP was inversely related to baseline PRA (r=-0.52; p=0.02) and PRO(r=-0.6; p=0.01). Thus, during diuretic therapy positive relationships were detected between the integrated 24-hour blood pressure change (ABP monitoring) and baseline PRA, baseline PRO and ~RO. No significant relationships were observed for OBP measurements. There results demonstrate once more the greater accuracy of ABP monitoring in assessing the effects of antihypertensive treatment.

Key Words: ambulatory blood pressure monitoring-diuretics-office blood pressure - plasma renin activity - prorenin


E42 AUSCULTATORY VERSUS OSCILLOMETRIC AMBULATORY BLOOD PRESSURE MEASUREMENfS IN DIFFERENT POPULATIONS Maldonad~ ~ Topouchian J., Scuteri A, Benetos A, Safar M., Astnar R. Instillil de Recherche et Fannation Cardiovasculaire. Hopital Broll';sais -Med I- INSERM (U337) - Paris (France). Hospitais da Univen;idade de Coimbra- Serviço de Cardiologia - Coimbra (Portugal) Policlinico Umherto I - Clinica médica - Cattedra Gerontologia e Geriatria, Universitá di Roma.(ltalie) Ambulatory monitoring bas been reported to be more reliable and reproductiblethnn casual measurements to evaluate of blood pressure level. However, despite the many technological developments in ambulatory equipmcnt design, this tcchnique is based on tbe same metbods -auscultatory or oscillometric - than the casual measurements to detennine blood pressure. The purpose of tbis study, is to compare tbe reliability of tbe microphonic and oscillometric arubulatory blood pressure monitors to detennine blood pressure in different populations during a nonna! working day, being altenlive to the relevanee that weight and blood pressure may have in quality of data acquisition. A total of consecutive 296 asymptomatic, tmtreated subjects participated to tbe study (169 M; 127 F, aged 22 to 80 years). They were nonnotensives or tmtreatcd essenhal hypertensives, nonehese ar obesc. Ambulatory blood pressure measurements was performed at 15 minutes interval over 24 hours using, in a randomized order, either the microphonic device Novacor, or the oscillometric device : Spacelabs. The reliability of tbe refereed metbods to measure blood pressure was considered in the basis of the total number of perfonned readings during 24 hours and tbe absolute and relative nwnber of the successful measures recognized by the device and its software as correct. The comparison between tbe microphonic (n=l59) and oscillometric metbods (n=l37) showed, for tbe same recording period, a significant dilTerenee between tbe two metbods in tbe total population, in nonnotensive and hypertensive patients in non-overweight and overweight subjects, witb tbe better reliability for tbe microphonic metbod. There was no difference for tbe same metbod between nonnotensive and hypertensive patients~ whereas tbe comparison for tbe same metbod between normal weight and overweight patients showed tltat accuracy and reliability of the mentioned two metbods is worst in overweight subjects. As far as the present devices were considered our data strongly support auscultatory metbod as tbe better indirect metbod for arubulatory blood pressure monitoring, in what concerns to reliability and accuracy of blood pressure measurements.

Key Words: Oscillometric - Auscultatory - BP monitoring - Blood pressure measurement

E44 BLUNTING OF NlGUT-TIME BLOOD PRESSURE FALL IN DIABETIC HYPERTENSIVE PATIENTS WITII SEVERE AUTONOMIC NEUROPATIIY J Medina, J Polónia*, E Rodrigues, A Barbosa, C Neves, A. Santos, S. Endocrinologia & Un. Farm ainica, Fac. Medicina do Porto, Portugal.

With 24-h ambulatory blood pressure monitoring (ABPM, readings taken every 20 min) we studied the day-night circadian variations of blood pressure (BP) in 28 hypertensive diabetic (insulin, ID and non-insulin dependent, NID) patients (24-67 years) and in 22 age- and 24h BP-matched non diabetic hypertensives. Severity of diabetic autonomie neuropathy (DAN) was assessed by the total score (ranging 0 to 10) of the five cardiovascular function tests described by Ewing (the higher the score the more severe DAN). Day-night delta BP is the percentual nocturnal BP fall v daytime BP. Results are mean±SEM. Camparing to non-diabetic hypertensive patients, for similar 24h-BP values, diabetic patients showed only for SBP (systolic, mmHg), higher nocturnal SBP values (128+3 v 122+2, P<0.05) a smaller delta SBP (11+1 v 14+2 %, P<0.01) and an increased variability (standard deviation of the BP data) of daytime SBP. In the diabetics the score of DAN was negatively correlated to delta SBP (r=-0.54, P<0.01) and positively correlated to the variability of SBP during daytime(r=0.52, P<0.01) and to the duration of diabetes (r=0.49, P<O.OI). When diabetics with different scores of DAN (<': 5, n= 15 and <5, n= 13 ) were compared, the more severe DAN was associated to higher nocturnal SBP (135 +4 v 120+1mmHg, P<O.OI), lower SBP delta (8+1 v 15+1%, P>O.OI), higher SBP daytime variability and Jonger duration of diabetes but oot with a different prevalenee of ID or NID. Conclusions: DAN in hypertensives is associated with blunting of circadian variations of systolic BP; ABPM 's data may be of value in diagnosis and evaluation of DAN. Key Words: Diabetic autonomie neuropathy, circadian variation, ambulatory BP monitoring, hypertension.

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E45 AMBULATORY BLOOD PRESSURE MONITORING: QUALITY CONTROL AND IMPLICATIONS FOR CLINICAL TRIALS IN HYPERTENSION. T Denolie B Vaisse, D Herpin, S Boutelant, V Gressin, R Asmar, Saint Mala, France.

The quality control of ambulatory blood presaura racordngs (ABP) in clinical bials is rarely pelfoonecl. In a multicenter study in 407 hypertansive patienls, 735 ABP were analyzed (Spacelabe 90207 : 624, 28 centers ; Novacor : 111, 5 centers) : 375 aftar a 6-week traalment with eliazapril and 360 alter an additional &-week traalment with eliazapril alone or combined with either isradipine, hydrochlorothiazide or bisoprolol. Con1luterized data

ware centrally analyzed. An ABP was considered as valid W the following criteria ware lullilled : BP maasurement fMliY 15 minutes ciJring 24 houls ; ABP start between 7 and 11 AM, ~ 48 validaled BP readngs, no more than 2 non consecutive hours without validaled BP measures. Readngs ware automatically edited if SBP ~ 50 and s 300 mmHg, DBP ~ 30 and s 200 mmHg, SBP - DBP ~ 20 mmHg if SBP ~ 140 mmHg and SBP - DBP ~ 10 mmHg if SBP < 140 mmHg, 40 s HR s 200 bpm. The maan nuniler of

validaled maasuremanis was 85 ± 13 (Spacelabs : 86 ± 12 ; Novacor: 78 ± 21). One or the 2 ABP ware excluded in 17% of patienls (651375) : 13% (47/375) at day 42 and 9% (341360) at day 84, forthe following raasons:

Day 42 (n = 375) Day 84 (n = 360)

ABP duration < 24 hrs 81 84 validaled BP readings< 48 11 7 1 hr with no reading 4 5 ~ 2 hrs with no reading 43 38

ABP start< 7 or > 11 AM 15 10

T nal siZe may be raduced when ABP 1s used, comparad to casual BP measuremen~ because of the better reproducibility of this technique (standard deviation of the dillerences of 9.1 and 5.9 at day 42 and 84, respectively comparad to 14.3 and 9.1 mmHg). However, quality control of

ABP should be perfonned, teading to increase the study popuiatien by 17%

Key words : ambulatory blood pressure monitoring, clinical bials, quality control, sample size

E47 HOME BLOOD PRESSURE MEASUREMENTS: RELATIONSHIP WITH CLINIC AND BLOOD PRESSURE MONITORING.

Mlllt.J1., Cottone S., Piazza G., Volpe V., Lisi A., Galiano S. and Cerasola G. * Chair of Internat Medicine and Hypertension Center - University of Palermo- Italy

Qb.il:l;liye: The aim of this study was to compare home blood pressure (HBP) measurements recorded on both non- and workday, with clinic blood pressure (BPc), daytime and 24h- arnbulatory blood pressure monitoring (ABPM). Desjgn and Methods: Nineteen essential hypertensives (10 Mi 9 F), with meao age 42.2 ± 7 years, after a wash-out period of 15 days, onderwent the evaluation of BPc, 24-h ABPM (Spacelabs 90207), and home blood pressure measurements (OMRON HEM-713 C) at 08:00 a.m., 4:00 and 8:00 p.m., on both non- and workday. Moreover, plasma adrenaline (A) and noradrenaline (NA), in both resting and standing position, were obtained. ~: Systolic and Diastolic-HBP values sbowed no differences with both 24h-SBP/DBP and DAYTIME-SBP/DBP and were significantly lower than BPc (p < 0.05).

24h-ABPM

NW: non- workday - W: workday • P< 0.05 - A p < 0.01 - § p < 0.005 - # p < 0.001 We found no correlation between basal plasma levels and percentage increase of A and NA with BPc, HBP and their differences. Conclusiops: Our results seem to demonsttate the usefulness of HBP recorded at 08:00 a.m. and of the average of home measurements in the follow-up of hypertensive patients.

Key words: monitoring

Home blood pressure. Ambulatory blood pressure


E46 ALBUMINURIA, LEFT VENTRICULAR MASS INDEX AND 24-H AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH ESSENTIAL AND SECONDARY HYPERTENSION. M.Lapióski,AJanuszewicz,E.I>.tbrowska,AKuch-Wociai,H.Berent, B. Wocial, W.Januszewicz Department of Hypertension and Angiology, Academy of Medicine, Banacha la, Warsaw, Poland

The aim of the study was to delermine alburninuria, left ventricular mass index (L VMI) and to perform 24-hour arnbulatory blood pressure monitoring in patients witb essential and secondary hypertension. The study was performed in 20 pts with essential hyperlension (EH)

(4F,I6M;mean age: 42 ± 2 yrs), 12 patlenis (3M,9F;mean age 41:±:3 yrs) witb pheochromocytoma (PHEO), 11 pts ( 3F,8 M;mean age 42 ± 4 yrs) with renovascular hyperlension (RVH), 8 pts (5F,3M; mean age: 45 ± 3 yrs) with primary aldosteronism (PA) and 11 healthy normotensive volunteers ( C ) ( 2F, 9M, mean age: 40 ± 2 yrs). During 24-hour arnbulatory blood pressure monitoring (24-ABP) measurements were taken every 15 ntin in day-time (6.00-23.00) and every 20 ntin in night-time (23.00-6.00) with monitor 90207 by SpaceLabs. Simultaneously urine for alburnin excretion was collected. Albuntinuria was measured with immunotorbidimetric method. Echocardiography was performed in all tbe patients.

Albuminuria was significantly higher in R VH than in EH, PA and PHEO (80:±:29 vs 21±3; 25±17; 26:±:11 mg/24h; respectively;p<0.05). In EH, RVH, PA and PHEO alburninuria was significanlty higher as compared with C . SBP 24h and DBP 24h was significantly higher in RVH and PA as compared witb EH , PHEO and C . No significant diJierences in L VMI were found between EH , RVH, PHEO and PA, being higher than in C . No correlation was observed between alburninuria and SBP24 h, DBP24h and L VMI in all groups. Our results indicate that patients witb R VH are characterised by more pronounced alburninuria than patients with EH , PHEO and PA , what may indicate the impairement of renal function in patients with this form of secondary hyperlension .

Key Words: alburninuria, primary and secondary hypeneosion

E48 ACCURACY OF MICRO AM 5600, A BLOOD PRESSURE At\fBULATORY MONITORING DEVICE, VALUATED DURING EFFORT STRESS TEST.

C. Ascioti and G. Ferlaino.

Cardlology Service and Coronary Care Unit, Hospita! ofLamezia Terme ( ltaly).

The most part of tbe protocols actually in use for tbe validation of Ambulatory Dlood Pressure Monitoring (ADPI'vt) devices, valuate their reliability at rest; little is known on the con1Iary about the reliability and accuracy of these devices when valuated during dynarnic conditions.

Airn of our study bas been that to verify the accuracy, during elfort stress test, of a Micro AM 5600 (Kontron lns1ruments ), an Holter ECG and ABPM recorder, comparing Systolic and Dyastolic Blood Pressure (SBP and DPB) values, obtained with Micro AM to those nbtained with •phygmnmannmetric methnrl.

15 patients ( mean age 57 ± 5.4) have been se1ected and all of these were :;,ubmitted to an ABPM by means ofthe MICRO AM and contemporary to an elfort stress test by means of a cyclo-ergometric system. BP values detection were carried out simultaneously in the same arm by collecting the two different BP detection system via a T tube. We have obnained tbe following resulls:

SBP DBP SBP DBP SBP DBP ... Uillil - wiu - II!ÏI! SpbypiD 156.: 85.0 210 110 110 60 SDP-.978 ;50001

±27., ±12.4 Micro AM. 156.0 8!.2 224 110 121 60 DBP-.903 "0001

+2R.7 +11.7

Statistical analysis: a linear correlation test was used. Conclusion: tbc MICRO AM 5600 bas shown, during elfort stress

test, a very good reproducibility in deleetion BP values, especially when these values are compared to those obtained by means of sphygmanometric method.

Key Words: Illfort stress test, Dlood Pressure Arobuiatory

Monitoring Device.

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E49 SELF-MEASUREMENT OF BLOOD PRESSURE ON THE ASSESSMENT OF ANTIHYPERTENSIVE ACTIVITY OF DRUGS: THE CASE OF TRANDOLAPRIL Joscp Redon*, JV Lozano. Hypertension Clinic, lnternal Mcdicinc. Hospita! Chnko. University of Valencia. Spain Tbc objcctive of the study was to asscss the antihypertcnsiYc actlvity of Irandolapril beyond 24 hours in mild-moderate essential hypertcnsives by using self-measurcmcntof BP (SclfBP). Design and method. Aftcr a 2 wceks run-in period patients en try a trcatmcnt period (trandolapril2mg oid, in thc morning) during 4 weeks. Casual BP (CBP) (thc avcrage of thrcc readings) was measured using mercury espbingomanometer and semiautomatic device. SclfBP (thc mean of two readings) was roeasored at thc time of a wake. beforc lunch, beforc dinnerand again aftcr a wake. using a semiautomatic dcvice.CBP and SelfBPwereobtainedcvery week and24 and 48 hours after thc last dosc of Irandolapril at fourth week. Rcsults. Ninty-two patients (43 men, mean agc 55±11; bmi 28.1±3.7 kglm2 , CBP 162± 16198±8 mmHg) were included. Thc diffcrencesof BP values between device and espbingomanometer were 1. 7±9.3 mmHg for systolic and 0.8±7.2 mmHg for diastolic. A significant dccreasein CBP and SelfBP, higher for CBP (CBP 16.7/10.2 mmHg; SclfBP 8.515.8 mmHg) were obscrvcd. Sc1fBP between 24-48 h aftcr Irandolapril was slightly higher than those obtained during 0-24h ( 1.210. 7 mmHg, see figure). Antihypertensive activity over thc 48 hours period was similar in obese (bmi>30) and non-obesc subjects.

0-24 24-48 t;i 0 :r::

l -5

c.. lXI ,-10 Cl)

<1-15

1:11 SBP

- DRP

Conclusjons. The dcscrease in BP by treatment is lower in SelfBP than those obscrvedin CBP. Trandolapril reducesignificantly CBP and SelfBP :tldl,'lWbnltlrtensive activity were maintained beyond 24 hours after the drug intake. Self-mcasurcmentof BP can be uscful in the asscssmentof antihypertensive activity of drugs. BP self-measurement, trandolaprll.

ESt ASSESSMENT OF BLOOD PRESSURE AND CARDIAC OUTPUT BY NONINVASIVE CONTINUOUS FINGER BLOOD PRESSURE MEASUREMENT. C.J. Giot and J.P. Degaute• .

Hypertension Clinic, Erasme Hospita!, ULB, Brussels, Bclgium The aim of the study was to assess blood pressure measurements (BPM) by use of a Portapres which measures continuous blood pressure non invasively by plethysmographic metbod applied on the finger. Furthermore, we also assess the cardiac output measurcmcnts (COM) by the Portapres using the pulsc contour analysis applied to thc pressure wave output. The measuremcnt of ambulatory, continuous finger artcri al prcssure by means of pul se wave analysis Portapros has already been tcsted and validaled for BPM but there is no data in the litorature camparing COM by Portapres with invasive thermodilution method. The study included seven patients (age range 63 to 74 years) suffering from coronary vessel discase and who had undergone coronary artery bypass graft surgery. The measurements we re pcrformed at the intensive care unit. Invasive COM were detemüned by the thermodilution technique using a Swan-Ganz catheter and the invasive BPM by radial arterial catheter. l11e COM with Portapres were determined with the logiciel Fast. The different technique measuremcnts were performed simultaneously and repeated twice in each patient with an interval from I 0 to 60 minutes. We observcd that the correlation between the BPM with the 2 methods was satisfactory. Furthermore, the results showed that the COM with Portapres were slightly lower than the COIVI with thermodilution method. Nevertheless the correlaticn coefficient was good at 0.82. Non invasive continuous finger blood pressure measurement provides a novel tooi in the haemodynamic approach and non invasive evaluation of the patients.

Key Words: blood pressure, cardiac output, pulse contour


ESO BLOOD PRESSURE VARIABILITY AND ENDOTHELIUM DYSFUNCTION. F Perticone, R Ceravolo, F Pugliese, R Costa, R Maio, C Cloro, C Cosco, PL Mattioli. Dpt of Medicina Sperimentale e Oinica, University of Reggio Calabria, ltaly.

In hypertensive patients !he endolhelium-dependent vasodilation is impaired. There are some evidences that blood pressure variability (BPV), independenijy of BP levels, may reprasent a target organ damage. We designed our study to delermine !he possible correlation between BPV and vascular responses to acetylcholine (Ach). In 25 subjects (8 Mand 17 F; age 44±6 yrs) was performed an ambulatory BP monitoring (Takeda 2421) for BPV evaluation (as standard deviation of mean), and a strain gauge plelhysmography for foraarm blood flow (FBF) measurement. Endolhelium-dependent vasodilation was evaluated by dose-response rurve to intra-arterial Ach infusion (7.5, 15 and 30 Jlg/mV5min). A negative significant correlation was found between systolic and diastolic BPV and FBF at higher Ach dose (figure).

t t ~ ~

1 ~ fO "' ~ ., fD 0 10 "' 3) ., fD

FaMmatufRow(nt'fUJ~

A positive significant correlation was found belween systolic (r-.60, p<.01) and diastolic (r-.50, p<.02) BPV and peripheral vascular resistance. Any correlation was found belween dinic (BP=156196±19110 mm Hg) and 24-h BP values (141185±1818 mm Hg). In conclusion, our data shOINI'l that BPV may be considered a predietor of endolhelium dysfunction.

Key Words: enelolhelium function, blood pressure variability, blood pressure monitoring.

E52 REFERENCE VALUES FOR AMBULATORY BLOOD PRESSURE MONITORING IN AN ELDERL Y SPANISH POPULA TION

F. Blanco, C. del Arco, C.Suárez, T. Sáez, I. Garcia-Polo, R. Gabriel. On behalf EPICARDIAN Study Group. Hospita! de la Princesa. Madrid. Spain.

The objective of the present study is to delermine the references values lor ambulatory blood pressure monitoring (ABPM) in a group of elderly spanish people (age >=65)

In 333 randomly selected subjects a 24 hours ABPM (measurements at intervals of 15') was carried out using an automatic ABP monitor (Spacelabs model 90207); 302 subjects had a valid ABP recording (higher than 80% of valid lectures). Mean age 74 years, 134 males. Three groups were studied: 1) hypertensive patients on trestment (n=105); 2) individuals without trestment (n=197, including nonnotensive and hypertensive) and 3) the whole sample (n=302). Mean values of the following variables were analyzed: -24 hours BP: systolic (24h-SBP) and diastolic (24h-DBP) -diumal BP: systolic (DSBP) and diastolic (DDB) -nocturnal BP: systolic (NSBP) and diastolic (NDBP). Sleeping hours defined the noctumal period. A Wilcoxon test was perfonned.

The following results were obtained: ontreatment p total without trestment

n 105 302 197 •24h-SBP 131.6~ 15.2 .07 128 ± 14 .23 126.1 :!:.13.8 •24h-DBP 74.5 ± 7.7 .056 72 :!:.8 .20 71.6 ± 7.9 ·oseP 135.4 ± 14.6 .06 132 ± 14 .22 130.2 ± 13.7 ·ooeP 78.5 ± 8.1 .09 76 i 8 .27 76.1 ± 8.4 •NSBP 126.1:!:. 17.9 .07 122 ± 17 .24 120 :!:. 16.1 •NDBP 68.7:!:. 9.3 .26 66 :!:.9 .14 65.2:!:. 9

•expressed as average ±. standard deviation.

No significalive diflerences were observed neither between total group and patients on trestment lor hypertension, nor between total sample and individuals without treatment (hypertensive or nol). So these values could be used as raferenee ones for ABPM in the elderly.

Key Wordi\mbulatory Blood Pressure Monitoring, hypertension, elderly

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E53 WHICH 24-h ABPM VALUE IS EQUIVALENT TO 140/90 mmHg BY CASU AL MEASUREMENT IN THE ELDERL Y? .Stiarez C,Arco C, Blanco F, Saez T, Gabriel R. On behalf the EPICARDIAN Group. Tbere is not agreement about the 24-h ABPM value which

corresponds to 140/90 mmHg by casual measurement. It is perforrued a cross-sectional survey of the civilian, noninstitutionalized elderly population (older than 65 years old) (n=3,000), including an in-home and an office BP measurement. A 24-h ABPM recording was perforrued in 300 subjects. A wake and sleeping periods were defined. Tbe following variables were evaluated: average of two Systolic and Diastolic home BP readings (SBPH, DBPH), average of two Systolic and Diastolic office BP (SBPO,DBPO), average of 24-h Systolic and Diastolic ABPM (SBP24, DBP24) and average of Systolic and Diasto1ic BP during the awake period (SBPA,DBPA). A regression linea! was perforrued between casual and ABPM values. Tbe equivalence to 140/90 mmHg was calculated tor ABPM values.

x r y x r y

nm1Hg mmHg mmHg mmHg

SBPH .60 SBP24 DBPH .48 DBP24

140 125 90 75

SBPH .60 SBPA DBPH .47 DBPA

140 129 90 79.5

SBPO .57 SBP24 DBPO .45 DBP24

140 124.8 90 74.3

SBPO .58 SBPA DBPO .48 DBPA

140 128.7 90 78.9

'"" "o.·m eqmvalent valnes to 140/90 mmHg y casua1 rea dings are 10 mmHg lower than the casual one if you consicter the awake period and 15 nnnHg lower in the case of 24-h period, tür both SBP and DBP.

Key Words: ABPM, elderly, reference-values

ESS BODY FAT DISTRIBUTION, AMBULATORY BLOOD PRESSURE MONITORING (ABPM) AND PLASMA LIPID PROFILE IN ESSENTIAL HYPERTENSION.

CA Feldstein*, M Akopian, AO Olivieri, H Chavin, S C auterucci, R Paladino, F Passarini, E Salvatierra. Hypertension Program, University of Buenos Aires and Health Sciences Institute, Buenos Aires, Argentina. The aim of the study was to evaluate the association of anthropometric measurements and serum lipids with casual BP and ABPM in men with untreated essential hypertension. There were examined 89 men, aged 18-84 yrs. Blood pressures were measured in triplicate with a mercury sphygmomanometer. ABMP were obtained on a workday with a TM 2421 (AND CA) taken readings at 15-min intervals during the day and at 30-min intervals during the hours of sleep. Averages were then be calculated for three intervals: 7AM-1PM; 7AM-ll PM, and 11 PM-7AM. Total cholesterol, HOL-cholesterol, and triglycerides were measured using established guidelines. Height was significantly correlated with DBP 7 AM-11 PM (r=0.223, p<O.OS); waist circunference with casual SBP (r=0.302, p<O.OS) and DBP (r=0.293, p<0.05) and 7AM-11PM DBP(r=0.2, p<O.OS). BMI and waist/hip ratio were significantly correlated with DBP 7AM-11PM (r=0.34, p<O.Ol, and r=0.203,p<0.05, respectively). Lipid valnes were not correlated with casual, ABPM or anthropometric measurements. Multiple regression study showed that waist circumference and BMI showed the ciosest correlations with casual and ABPM.

Key Words: Body fat, ABPM, serum lipids


E54 HOME BLOOD PRESSURE DURJNG PREGNANCY ESTAHLISIIME."J'l' OF STANDARDS OF NORMALCY T Dcnolle1, C Calvez2, JN Ottavioli3, V Esnault4, D Herpin5, P Lebon6 1: St Malo, 2: St Brieuc, 3: La Roche SN on, 4: Nantes, 5: Poitiers, 6: Le Mans; Francc The aim of this study was to establish home blood pressurc

(HBP) standards of normalcy during the three different gcstational 3 month periods. One nurse in each hospita] taught pregnant women HBP and gave them usually on Monday mominga semi-automatic oscillometric device (Hestia Pharma 02 used in Hot Study) after calibration against a standard mercury manometer. After informed consent, 30 hcalthy pregnant women without history of hyperlension (age: 29 yrs, range 23-36 yrs) underwent BP measurcment 3 times bcfore breakfast and 3 times after dinner in scated position from Monday evening to Saturday evcning. Meaurements taken on Monday evening were excluded. Only pregnant women wilh 3 good quality monitorings carried oul before 16 wecks of gcstalion for the lïrst 3-month period (mean: 12), bet\\'een weeks 17 to 29 for thc second 3-month period (mcan: 23) and after 30 wecks forthelast 3-monlh period (mean: 34) 11 ere analysed.

I. Comparison of semi-automatic mcasurements and manual office BP mea~urements bv the nurse:

Office BP: 116±11/ 67±8 mmHg Oscillomelric BP: 112±13/67±8 mmHg

2. HBP in healthy pregnant women: Firsllrimestcr: 103± 8/ 60±7 mmHg Secoud trimester: 103±7/ 60±9 mmHg Third trimester: 107±7/ 63±8 mmHg (p<O.Ol) From these normal values, pregnant women with HBP >

119174, 117178, 121179 mmHg respectively during lhc 3 geslational 3-month pcriods have probable hypertension. HBP after 30 wecks of gestalion was significantly higher lhan during thc 2 others gcstational periods. These HBP rcsults are comparable lo publisbed ambulatory BP normal valucs.

Key words: Home blood pressure measuremcnl : Prcgnancy: normalvalues

E56

BLOOD PRESSURE MONITORING IN ESSENTIAL

HYPERTENSIVES TREATED v/ITH QUINAPRIL AND

HYDROCHLOROTHYAZIDE ~~iagini, G. Busi,

G. Roscio, F. Pasquazzi Infermeria Pre-

sidiaria A.M. 2° R.A. ROMA

We enrolled 50 patients,42 men (mean

age 49r 5 ys) and 8 women ( mean age

45= 4 ys) with systolic blood pressure

( SBP) between 160 and 200 mm Hg and

diastolic blood pressure (DBP) between

90 and 105 mm Hg. After 2 weeks of phar

macological wash-out,we recorded an

E.C.G. and an echocardiographic exam in

all patients;besides the circadian beha

viour of blood pressure values was stu

died in all patients by non-invasive,

automatic,intermittent monitoring. All

patients were treated with a combination

of Quinapril 20 mg + Hydrochlorothyazide

12.5 mg for a period of 12 weeks,starting

with 1/2 pill and doubling the dose in

non-responding patients after 2 weeks.

The monitoring of blood pressure,perfor

med at the end of treatment,showed a

significant reduction both of SBP ,

(-12.4% ) and of DBP (- 11.2 %).Moreover

a significant diminution of the hyperten

sive peaks was noticed during daytime

recordings. Heart rate showed no signi

ficant change at the end of treatment.

Key Words: Blood pressure monitoring.

Quinapril. Hydrochlorothyazide

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